Soap reflexion Week 3 – December 9 , 17

[Alpana Garg]

After attending the Friday meeting and going through the videos I learnt that health insurance in USA and the current health system is complex and has many problems which cannot be changed in a day and it will take time. However what I can do as a doctor and help any way is to use whatever resources I have , in a judicious and intelligent manner and not to waste any bit of it add to the expenditure . For that its important to have clarity of thoughts as a physician regarding what tests to order , how to diagnose without excessive testing and use clinical knowledge to the best of our ability to help the patients.

[Mohammad Rauf]

I believe everyone has a right to healthcare. This is an issue that has been under addressed. I always believed health insurance to be a hindrance to universal healthcare. Insurance acts as a middle man in the patient doctor relationship, they have to make money and its both the physician and patient who suffer. The system has to be overhauled. The cost of healthcare has become a major hindrance in providing people with the care they need. I was shocked to hear that many insured people don’t go to the doctor because they fear the cost of care. Every time I prescribe Lantus or an ICS inhaler I have to hope that the patient will be able to obtain it from their insurance.

[Hibah Ismail]

This week’s topic was one which could be applied the patients that we see on an every day basis. It is without a doubt that each of us has seen a patient that has not been able to attend to primary care services, obtain medications, or perform screening tests due to insurance coverage. In fact just this week I have had 2 patients that had not been seen by any physician due to loss of insurance; one of which was an HIV patient who has not seen his ID doctor since February 2016 and has not been able to obtain his HART therapy nor any prophylactic medications. For sure, the patient had been infected with opportunistic infections and had to be admitted to the hospital for further workup and treatment due to his clinical condition.

After discussion of health insurance during this clinic week, it is clear that health insurance is a very complicated topic that will need huge amounts of power and efforts to be adjusted in order to fit the majority of the population. However, a very important note that can be taken from the discussions and the videos is actually what we can do to help our patients in the most affordable way possible. Which test really needs to be ordered and which medication is cheaper for our patients to obtain? Which resources are present in our community that can help our patients get the most appropriate treatments with the least possible cost. These are the questions that we can actually search and question during our encounters in order to provide our patients with the best care whilst the bigger and more complicated healthcare ordeal gets worked on.

[Scott Smith]

The state of the health care system in America is something I have been passionate about for sometime. I’ve always had an interest in politics and then I wanted to be a doctor so this is the natural conclusion to my interests. Our healthcare system is decent by some standards but terrible by others. With the passage of the ACA most people in this country now have some form of insurance coverage but there are still many that do not either by choice or by barriers. The ACA was a step in the right direction but not nearly enough in my opinion. It is an ethical mess for healthcare to be a for-profit business. It is a complete travesty for people who are responsible for another’s health to put the bottom line before that person’s well-being. There has been great progress however. The EMTALA of 1986 guarantees a sick person won’t die begging for treatment outside of an ER (Maybe a dramatic example) but it wasn’t followed up with a solution of how the hospital’s expenses will be covered. The expansion of medicaid and the subsidizing of private health insurance made a dent in reducing uncompensated costs by getting more patients insured. The ideal and ethical solution in my opinion would be to make the paying for and care of patients a public good. A one payer system in its best state would reduce overhead costs by eliminating redundancy in the system and make everyone insured (If you would even call it insured). An additional problem that needs addressing is making primary care more available and more attractive to doctors. The Department of Health and Human services already has a large community healthcare system in place that could be expanded and include mental health and dental services, but without federal dollars these are in danger of closing. More physicians and health care workers being involved in politics would see positive changes to our healthcare system.
Capitalism may work for consumers in many examples, but patients aren’t a typical consumer. They have little knowledge on the goods they consume and often don’t have the luxury of shopping around for the best deal. There is also no transparency on the cost of the care they have. A wealth of money shouldn’t determine access to good health

[Nadine Abdallah]

Unequal access to healthcare is a problem I hadn’t encountered during my years of medical school. However, during my clinic weeks, I saw more and more patients without insurance, who not able to pay out of pocket for their medications. This made me feel helpless at times, including times when I wanted patients to monitor their blood pressure at home, but they could not afford to buy a BP machine, when I ordered referrals and diagnostic testing that were not done because of lack of insurance, or when they were lost to follow up for months because they lost their insurance. Recently, I saw a patient in clinic who was lost to follow up for a year because he lost his insurance, and came to clinic with hypertensive urgency (possibly emergency). He was worried about going to the emergency department because he would not be able to afford it. We contacted the ED and arranged for him to meet with a social worker there, and reassured him. I have learned from my supervisors some ways to overcome these limitations and work my way around them, but a lot of the times I still feel helpless, and it is very frustrating that a patient with no insurance has to give up on necessary testing or medications. Healthcare should not be a privilege, but a right. During our discussions, it was striking to hear stories from other residents not only about their patients but also about their personal experiences. Even we as residents often defer visiting the emergency department to avoid the expensive bill.
In the remainder of my training, I will work on finding ways to overcome these limitations, and find alternatives to offer patients so that they don’t have to give up a necessary medication, or blood test. Fortunately, our supervising attendings have been a great source of such information.

[Ali Saker]

Lack of insurance/adequate insurance has serious sequalae on individuals, families and the societies, resulting in decreased adherence to treatment plans, decreased utilization of lower cost preventative service, increased utilization of emergency visits, and consequently leading to negative clinical and economic outcomes.
I have witnessed multiple inpatient scenarios when we were not able to discharge a patient due to lack of insurance to cover lifesaving medications. It was frustrating knowing the cost of the extra hospital stay exceeds by multiple times the actual cost of the medications. In the outpatient setting, the same problem reemerged again in different scenarios when patients were not able to afford a prescribed medication. I have learned from last Friday to think carefully about any test before ordering it, and to always look for affordable medications alternatives before prescribing them, always after counseling my patients and letting them contribute to the decision process.
The videos have raised my awareness to the flaws in the health system, and how patients are dealt with as uninformed consumers in a lot of instances. The help of our seniors and attendings has been tremendous in understanding and overcoming these barriers to a good comprehensive medical practice.

[Kunwardep Dhillon]

Healthcare- right or privilege? One of the questions that was thought provoking in our discussion. The answer is simple but not straightforward, healthcare should be a right but health insurance should be a privilege. Every individual should have access to affordable healthcare but at the same time avoiding exploiting the system if the individual has a “better insurance”
The videos showed two perspective of health care and insurance- first one in a developing country where physicians are forced to do extensive workup for common cold for financial incentives and patients get to choose what investigations/treatment suits them, second one in a developed country where insurance companies get to modify the workup/treatment a physician wants to do for an underlying diagnosis.
During this clinic week and many before, I have had multiple encounters but would like to mention one here- A young female patient coming with persistent cough and sputum production for past 4 weeks, this was her 4th visit to the clinic for the same complaint and a chest X-ray was ordered on last visit. Patient was unable to get CXR as her co-pay was 250$. This forced a thought that 250$ is a big amount for a basic diagnostic study which probably will be followed by further diagnostic/treatment modalities raising the cost of health care. This is not affordable healthcare. At the same time, I am more aware of things to consider before ordering workup and try to find alternatives to offer patients so that necessary blood tests/ imaging or treatment is provided

[Author]

Posts