[Red Cohort] Module 4

[Adam Qazi]

Please submit your SOAP Reflection below:

[Hussam Tabaja]

The cost of medical service has always been a dilemma in our practice. It seems that with further advances made in the medical field, medical attention is becoming more and more expensive. Unfortunately, this is coupled with the fact that healthcare is evolving into a large business entity set to make profit whether at the level of the institution or the individual physician. We can all probably point out to a time where we were shocked when we found out how much a single blood test or a radiographic image costs. Even more shocking is the cost of certain medications. All of this has developed inequalities in resource allocation and healthcare, where people who are insured or have good income are able to access medical services while others are not. Moreover, this has led some physicians to perform uneccessary procedures for their personal profits.

My reflection today is not about a single patient but a couple of patients. The best examples I can give are about patients that I saw back in my home country, Lebanon. I have seen many patient’s leaving against medical advise from the emergency department due to financial issues. I have also witnessed many patient’s not provided with any care in the emergency department as long as their condition is labeled “not critical.” This has somehow made me feel guilty because I’m a part of a medical system that deprives care to a big portion of the population, the uninsured. I’m also sure, based on our reflections during our meeting on Friday, and based on what we heard on the youtube videos, that the problem here in the US is as bad, if not even worse.

[Amjad Kanj]

We have seen uninsured patients go to the ED to obtain their primary care. Primary care clinics are very expensive for the uninsured and free clinics are very few with extremely long wait times. What happens after is that hospitals will have to pay much more money than what is paid in clinics for the care of these patients and then this money will come out of our pockets (taxes). This is why I believe that large hospital systems in the country have an obligation to establish free clinics all over the area of their work. This way, uninsured patients will get the care they need, for free and in a timely fashion. At the same time, the hospitals and their EDs wont have to deal with patients coming for primary care.

[Amir Laktineh]

Coming from a country were health insurance is not a common thing, and people go to the hospital in case of emergency only due to expenses, I thought the health system here is different and offer more to the patient once they have insurance, and anyone will have access to medical insurance regardless of their income. Unfortunately, After few months in residency, I figured out that insurance doesn’t cover the whole bill, and a lot of patients had to go the ED to simply refill their medications since a clinic visit won’t be covered or will cost them more than they can afford. I also noticed that a lot of patient comes only for their annual exam just to get the form(annual physical exam form) submitted to their companies or employers, and the majority will avoid any testing even age appropriate scanning due to expenses(can’t afford co-payment).
I feel like being in one of the most developed countries on Earth, every individual should have the right to have access to the medical insurance and the health system regardless of their SES and if the patient can’t afford the cost, then we should provide free service to maintain their health. The more we see and assess the patients in the clinic and adjust their medications, and f/u on their chronic conditions closely, the less they will be admitted to the hospital, and the less expenses the hospitals will have to pay eventually.

[Abdelaziz Mohamed]

The cost of medical treatment has been the greatest pain for all. Over the years I have been privileged with working in a 3rd world country, Sudan, then the UK and finally the USA. I have seen different health systems, broken and working and being fixed. The main question that has always been the same in all countries, is how much it will cost and when can it be done. Whether the payment has to be current or delayed it is always a headache. In the UK the major difference is that it takes longer to get elective treatment and it costs the NHS rather than the individual, which at the end of the day tends to circle back to the individuals insurance.
Having did the case and watched the Tedx videos it kinda all falls in the same context.
That being said I am re-cognizant of that issue everyday in the hospital and in clinic, making sure that I ask my patient if they can afford medication and providing them the information needed. So often that my patients do not know how much it will cost them in co-pay so I always ask them to call their insurance or ask the pharmacist about the cost, and ask for alternatives if available or PA if possible. The root of the problem is bigger than one person and I honestly feel helpless so many times.

[Alaa Akhras]

Unlike many of my colleagues, I have not had the privilege to practice outside the US nor did I ever have the opportunity to experience the different forms of health care abroad. However, it does not take someone with outside experience to see that there are still hurdles that need to be addressed in regards to the cost of medical treatment. This is a giant issue that I feel is not being displayed in the media as much as it should. Most of the issues that are of concern involve the younger generations and many are healthy individuals and have little to no concern of medical issues including medical care. Whenever you hear about the new healthcare bill its rarely about the laws themselves but more about republicans vs democrats and has become more of a circus rather than a serious topic. I believe that as young physicians we need to find ways to bring these issues to the attention of our younger non-healthcare peers and work together to find solutions in regards to this failed system.

[Hamza Salam]

Health care in the US is based on a business model, its a for-profit system and I will talk about it in that specific terminology as the problems encountered in health care can be dealt in the same way as any other for-profit system outside of health care deals with it. This model of health care is mostly perceived in a negative manner but I believe no design is ever completely flawed or completely perfect. Each design has its pros and cons. I believe our goal at this stage and time should not be to try changing the whole system and structure of health care but we should evolve within the current system and take advantage of the pros and find ways to overcome the cons. The design of the health care system is a hot political debate, although change is needed, it takes time and systems need to evolve.
The definition of “good health care” would vary from person to person of different economic, social and geographical backgrounds in the US depending on the disease profile and economic conditions. This is not just confined to the US but even countries with social health care have a health care discrepancy and limited resources. The pros of the current, capitalist model in healthcare enables pharmaceutical companies to put money in research and design treatment modalities faster than any other nation, this has given healthcare in the US a technologic edge over the rest of the world. New treatment modalities such as gene therapy and the wide availability of monoclonal antibody medications are more widely available here than any other nation. The cons, of course like any other business model or company include affordability, discrepancy in distribution to favor higher income areas and cost burden on the economy as a whole. I believe the solution to this should also be based on business lines and like any other business, lowering costs and increasing distribution needs mass production. In terms of health care, that means a wider, larger and effective primary care network with more physicians, easy availability of basic generic medications, social services, preventative health services. This would require more money and the roadblocks that are present are not because of health care being for-profit but because mass production has been limited in certain areas of the system. The lowering of prescription meds should be in the epicenter of any method or plan to lower budget and hence widen health care services eventually improving health care as a whole. “Mass production” is systematically controlled due to patents on certain medications and limiting import of medications produced outside the country, this practice has increased the price of health care and is against the nature of any capitalist business model. Patents for life-saving medications have reduced competitiveness between companies pushing prices higher. The elimination of patents (for life-saving meds) would result in competition between companies and would significantly reduce the prices of life saving drugs, the extra money saved can be channeled into the rural primary care system. This should reduce discrepancy and widen coverage to include more people who are less privileged to afford health care currently.

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