Wednesday, September 19, 2012

Is This What Health Care Needs?

Let me start this off by presenting my husband's, and my, needs for health care. Mr. BTEG has about six autoimmune disorders. Since there is currently no medical specialty that deals with autoimmune disorders in an overall sense, he must see a number of specialists that each deal with a particular facet of his issues; for example, he needs a gastroenterologist to help him manage his Crohn's disease, and an endocrinologist to help him with his thyroid issues.

My main health issue is mental, not physical. I am bipolar. This requires a psychiatrist to keep an eye on my mental state and help me adjust my medications accordingly. Thank God, I am currently in a good mental place in general and do not need to see my psychiatrist very often, nor switch my medication around. When things are more difficult for me, I sometimes see a counselor as well. Then of course both Mr. BTEG and I have a general physician, and our daughters have their health care needs too.

All of this brings me to an article about cutting out waste in health care. It caught my eye because the example patient, Harold, has rheumatoid arthritis, which is related to autoimmune issues, and because the author holds up the Cleveland Clinic as a model at the end of his article.

The Cleveland Clinic is, in general, definitely a good place to receive health care. It has a world-class reputation and some of their doctors are at the forefront of knowledge of various diseases and disorders. One of the problems I see in Cleveland, however, is that the Cleveland Clinic and its "rival," the University Hospital system, have largely sucked up most of the hospitals and many of the health care practices in the greater Cleveland area. Competition is good, and I would not want to see either the Clinic or UH completely dominate the Cleveland health care market.

However, having so much of a market controlled by two large systems also has its drawbacks. Both the nearest hospital to our home, and the best pediatric hospital in Cleveland, Rainbow Babies' and Children's, are in the UH system. Our family currently works with many doctors in the Cleveland Clinic system, both because of proximity to our house and because the percentage of solo practices does seem to be smaller. What if there is an emergency and we need to go to the nearest hospital, or one of our daughters, God forbid, gets an illness where a stay at Rainbow would mean the best care? First of all, that completely wipes out one of the advantages that the author above presents, which is computerized health records all in one place and readily available, due to everything being "under one roof." Secondly, doctors were already limited in what hospitals they could work with because of insurance. Would my daughters' pediatrician even have any privileges at Rainbow? But again, I would not like to see monopolization as the answer!

Secondly, we in the BTEG household know a lot about problems with health insurance. Our previous insurance provider would not pay for a very expensive health treatment which would have helped with all of Mr. BTEG's autoimmune disorders, similar to the problems Harold had with paying for Humira and Enbrel, which also work with autoimmune issues. However, Harold is also held up as an issue for waste when his declining health, based on not receiving the best medication for his issues, is mismanaged due to a multiplicity of doctors and lack of knowledge about his overall medical history.

Mr. BTEG prefers to have the freedom to choose his own doctors, whether they are in a particular system or not. Neither his gastro nor his endo doctors are in the Cleveland Clinic system; however, they are both excellent in their fields and moreover, they know each other professionally and readily share information with each other concerning my husband's issues (after my husband's consent is obtained.) Just recently, his gastro passed on taking bloodwork because his endo had also recently completed a blood panel, and "Dr. S is one of the few who knows what to get." Waste avoided, but not for the reasons our author describes. Also important, my husband "clicks" with his doctors. It is equally important for a patient to click with her psychiatrist and counselor. Sometimes it can take a while to find a health pro with whom you can feel comfortable. When it is already work to find the right doctor for you, why be even more constrained by what medical center, if any, they work for?

Is there waste in the medical field? Heck, yes. And steps should definitely be taken to avoid as much waste as possible. I simply disagree with what quality care must look like.

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