Guest essay: Who should health care serve?

By: Mark D. Schwartz, Esquire

​When was the last time you were able to talk to a doctor assigned by your health plan? It rarely happens anymore. Characteristically, people call their doctor when they are having a problem.  Yet what the caller hears first is a recorded message: “If you have a medical emergency, please hang up and call 9-1-1” Translated, this means, “Caller… we’re more interested in our legal liability than your problem.”

The very unhappy author, on medical hold (Photo: Mark Schwartz)

Callers who persist and stay on the line are directed through a host of prompts that merely add to the frustration, including suggestions that they go to a web site. So much for those without access to a computer or the ability to use them. And so much for the infirm or elderly.

Callers with time and infinite patience eventually reach a live person, generally a low-level intake person. One actual physician told me that these folk are paid what someone working at Target makes. It is an open issue who has more training. 

When I called my Penn doctor during the day, I was connected to someone clearly at her home, complete with her family talking in the background and a baby  screaming. When I asked where I had landed, she hung up. 

 Another time I called for an adjustment to my diabetes medication, telling the intake person that I had lost a significant amount of weight, down to 177 pounds. She said that she would get back to me. She did, at the end of the day, telling me that a blood sugar number of 177 was still high.

My startled response was, “ That number was my weight, not my blood sugar level.” Unlike asking a fast food server to hold the mayo from the burger, this is serious stuff with serious implications.

The web sites that we are directed to use for appointments and questions are full of “garbage in, garbage out” information leading to misinformation and misunderstanding.  From my experience, this simply necessitates more in the way of unnecessary back and forth than would be needed if I could just talk to someone with sufficient medical training or experience.

What’s that old saying? “One call to a registered nurse is worth thirty tweets?” But the health care system has taken those resources away from doctors and replaced them with the equivalent of fast-food workers. In the 15-minute doctor visit we might be lucky enough to get, the doctor examines his or her computer more, and us patients less. 

In contrast, not so long ago, I would call my personal doctor’s office  and speak with one of two long-time assistants who actually had medical training and knew me, my history, and how to respond. Health systems hire office personnel nowadays, not health personnel.  They are stuck with the results.  My personal doctor  tells me that staff come and go from their jobs with such frequency that he no longer bothers  to learn their names . “It might as well be McDonalds,” he says.  

​I once knew a politician who defined government as simply the process of “whacking up” pies of money. Now, with virtually all of my doctors leaving their practices, not on account of age, but from frustration, it is clear that the system is not about delivering care. Instead, for those running systems such as Jefferson, Penn Medicine and Main Line Health, its about maximizing profits and minimizing costs,  depriving doctors of the basic resources necessary to provide care.  It’s about whacking up money.

This has not happened overnight.   Blue Cross, ironically a “non-profit,” has long been about restricting health care payments, overpaying its politically-connected executives, and hoarding money that should have gone to providers. This has been going on for decades. The same can now be said about Jefferson, Penn Medicine, Main Line Health and any of the health care behemoths. For example, The Inquirer shockingly revealed that Jefferson paid more to its CEO than it provided in care for the region’s poor. Surely Penn Medicine and Main Line Health aren’t far behind when it comes to ridiculous amounts of executive pay.  

Physicians, like my long-term doctors, professionals dedicated to patient care, are being driven out.  

Our health care system is no longer about providing health care.  It is about extravagant and unjustified pay for those at the top.

13 thoughts on “Guest essay: Who should health care serve?”

  1. Nice whine, but what is the solution? We already spend more on healthcare than any other nation. Is the suggestion that we spend more? And even slashing executive pay to $0 would save only pennies of the multi trillion spent on healthcare.

  2. This is the face of corporate health care in the U.S. Expensive with shitty outcomes and over-testing. Removing the profit incentive and stop treating the care of the sick as a commodity would go a long way to fix this. And I have no problem with profits, just the way that the profit incentive and late stage capitalism have destroyed the care in health care.

  3. Seems to me that every civilized country in the world except us has figured this out: when profit becomes a motive in healthcare, the whole thing just doesn’t work. Ask any Canadian about their healthcare system and they’ll explain it to you. I know. I’ve asked.

  4. As a current resident of Houston, I am using the Methodist Hospital network of physicians, and they have something called “MyChart”. In brief, this is a method of bypassing all the terrible outcomes from phone calls and the use of websites. Instead, I can communicate directly any concerns I have directly with a particular Doctor’s office, from my primary care physician to my cardiologist, to my pulmonologist. I usually get answers within a few hours, if not sooner. This is at least preferable to what Mr. Schwartz describes, which admittedly, I went through before living here and is horribly frustrating.

    1. Yes, I have the same at Duke and UNC Health Systems. I also had the same at Jefferson when I lived in Philly. The “my chart” system is pretty ubiquitous across large health care settings. So I am not sure where this guy lives.

  5. The Epic computer system logs all your health care records. During a hospital visit or emergency event the Doctor or Nurses can retrieve your chart and review your past medical history along with speaking with the patient. The above process is how medical care is supposed to work. And it does work for the overall majority of patients. However with the enormous baby boom population our medical system can at times be overwhelmed. When an emergency occurs it is best to go to Urgent Care or the ER. I know it is costly to visit the ER but in an emergency this is the best solution to receive emergency care. The coming of AI will have both positive and negative effects on treatment. There is no excuse for a patient’s call to the doctor be ignored. I hope you lodge a complaint so the Doctor or hospital can correct their customer service problems and training deficiencies. Hope you fell better. I believe we Philadelphia residents have the best hospital systems around when an emergency occurs.

  6. When I was a kid and teen in the 1960s, my family of five were only one phone call or a two block from exceptional healthcare provided by our local pediatrician and family physician whose practices were housed in offices in the middle of our working and middle classes neighborhood. My dad, a tailor/fitter for John Wanamaker was able to afford it through his employer. When reviewing data for health care costs over the past decades, I noted that health care consumed only 7% of the GDP in 1969. When it was approaching 11% in the mid 80’s, the alarm bells rang and commissions to “contain” health care costs were convened to find solutions to cost containment. HMOs were the product of those efforts. Now, nearly 40 years later, health care is almost 20% (crazy) of the GDP and by all accounts is fundamentally a racket. You have echoed my experiences with the current incarnation of my family physician’s current practice model. I absolutely dread calling for an appointment now.

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