By: Grainne Rhuad
I can remember as a youth watching cold war era documentaries of Russia’s hospitals and health care systems. The long waits, the months before being seen, the serendipitous chances that sometimes occurred in order for families to get treatment. Or some people just had enough political and/or economic pull to get the treatment they needed. Following documentarians, we saw that many families had to make do without the benefit of what we would term essential treatment. Quotes from these people and this area were generally along the lines of “What other choice is there?” And “Truly we are blessed that half of the muscles in our child’s face work.” Along with that were the images of bread lines, poor living conditions, etc. We were fed the line that this occurred because Russia or the U.S.S.R. depending on how old and P.C. you are, had over-extended itself in its warlike behavior. Spending way too much on keeping up with the newest ballistics and spy tactics.
It’s both frightening and interesting to see that we have come to nearly the same place in our own “land of the free”.
Recently I suffered an accident requiring medical attention. I had cut the top portion of my foot accidentally with very sharp shears while gardening. As it was after hours my option was to visit a clinic or the hospital E.R. Clinics in my area tend to be faster and cheaper. This was my first personal awakening to the supreme change in health care in our country. A clinic, often called a “Prompt Care Facility” is designed to take non-life threatening trauma in order to free up E.R.’s to do the life threatening work. However they have office hours which end at 9:30pm in my neck of the woods. I arrived at 8:30 which I thought would be fine as I anticipated stitches and surely this could be done in an hour’s time.
Apparently I was wrong; the intake of questions took a good 40 minutes. Then when I finally got put in a room, although there was nobody else in the shop that night I waited another 20 minutes. When the Nurse Practitioner and her helper arrived the sideshow began. Neither of them knew where anything was in the room. Which I found slightly concerning and told them so. I also had to point them in the direction of the necessary tools, having been in the room for 20 minutes I had already acquainted myself with my surroundings, something it seems they hadn’t done even though they work there on a regular basis.
As it turned out there was more wrong with my right foot than I had counted on. So off to x-ray I went with the none too happy to be there late lab technician. In an effort to lift the mood which was heavy I started conversation with him. It was at this point that his Eyore-ish behavior was added to by his sailor’s mouth, which didn’t bother me overly but seemed a bit unprofessional. He didn’t know me from anyone else, and could have potentially really offended someone with his demeanor. His level of professionalism dropped drastically when my undressed wound began to bleed out in the x-ray room, In fact he became quite frantic and my companion had to run back to the clinic section to get supplies. It did not seem as if this technician had been at all versed in basic first aid and I had to direct him how to best help me. I did see his point though; there were no supplies in there which to me seems grossly mismanaged. I could see the wheels in his head spinning as he tried to stop the flow with no gauze, towels or any other useful implements. He was thinking ‘Am I going to get AIDS, Hepatitis, something else.’ I almost felt sorry for him until he started coughing and swearing all over me.
5 stitches later at midnight I was finally released, but not before I found out more about why services were so difficult. The Nurse Practitioner confided in me that just 5 years ago there would have been doctors on-call to assess and serve every type of injury. My cut tendon would have been dealt with that night; however this was no longer the case. Her take on it was that Doctors simply wanted to have a life. I think she was being charitable. For example with the number of orthopedic surgeons in my area, an on call rotation would only require 2-4 days a month. Also as it turns out most doctors who do participate in on-call rotations do so through a contracting agency. This means they get paid more and they mostly travel from out of the area.
As it was I waited for the whole of the next day back in Prompt Care to get a referral to someone who could work me into their schedule. We did finally find somebody and spend another 2 hours at his office waiting for him to come in and say yes, they were right now come back in 2 days. The doctor did admit that it would have been better to catch the tendon and repair it when the wound was still open and fresh, as it was the surgery I had to undergo would require a general anesthetic and as the tendon, a stretchy piece like a rubber band had moved up into my foot it took quite a bit of rooting around to find it. Ultimately all this caused me more pain than really was necessary had we had a good health care system in place.
So what about cost? For every office visit, there is a new billing. So in one in a half days I had been billed 3 times for the same injury. All this occurred when I have very good health care coverage. One wonders how long a wait and what kind of service there would be for someone with substandard health care coverage or no health care coverage.
When I got to the surgical center, which was an outpatient treatment center not affiliated with our local hospital I found out I would be billed separately for my three nurses, anesthesiologist, surgeon, and the facility. In addition to this every piece of this procedure had to be signed off on by both my primary care doctor and the insurance company reviewer.
This is the place where I feel the greatest change can be made by a national health care plan. A person who is injured should be able to walk into a hospital or clinic and other than a reasonable wait for life-threatened patients they should be able to have everything cared for without driving all over the countryside and spending days in offices. Doctors who assumedly went into that field to help should be on on-call rotations.
However, listening to the media during this last week I found the Republicans representatives in the Senate and Congress using bureaucracy as a talking point. Specifically they said “You don’t want bureaucrats telling your Doctor what he can and can’t do.” This seems really disconnected to me as we already have to wait for bureaucrats to tell us what is and isn’t allowable through our insurance companies. If my primary care doctor, who knows and sees me on a regular basis feels a certain medication is going to be the best for me and the doctor behind the desk at the insurance agency disagrees, who do you think wins? We already have to wait for approval for everything from medication to bloodwork. It just doesn’t seem like a good argument to me when we are seeing people not going to the doctor because they cannot afford it.
A good example of this was my attending nurse in surgery. We chatted a bit while I was being prepped and she showed me a scar on her foot that had been treated at home due to lack of medical insurance and poverty. She explained that she had squewered it with a jagged post. Her treatment? Spider Webs. Spider webs were collected from all over the home and her wound was packed with them. She said it stopped the bleeding immediately and the body absorbed them with no problems. She had no infection and the scar was quite small.
This got me to thinking, about what it is going to take to make a difference in our health care system. If we begin reverting to home remedies will Doctors change their minds about availability as they begin to lose potential income? Will insurance companies become less stringent about what they approve as people begin to bow out of their programs to treat themselves? Is a grass roots movement necessary to get better coverage for the average American Citizen? Or will prices simply go up to cover the costs of patient loss?