Does Your Doctor Answer Your Questions?

Have you ever been in front of your physician, nurse practitioner, or physician’s assistant and find your questions aren’t being answered? The current healthcare climate demands physicians spend less and less time with patients. Today, as insurances pay less and less to healthcare providers, employers are demanding physicians see more and more patients in an hour. For the average consumer, the problems of less time and higher insurance premiums present numerous roadblocks to meaningful, effective, and reliable discussions with your doctor.

We are a wealthy nation but mired down in a healthcare system which pushes a large segment of our population into poor access to a doctor. The insurance model, which we should know by now doesn’t work, is presently the only model we have. Cutting access to healthcare by shortening hospital stays, for example, just increases the cost of the hospital day. The false premise works like this. If there is a four day stay, which costs $1000 a day and the total stay is four days, the total cost for four days is $4000. If the hospital stay is reduced to two days, the total bill would be $2000. The truth is that the hospital doesn’t run more cheaply when its half full. The hospital still needs that $4000 they had been getting from the four day stay. So, the cost of the day increases to $2000 and the total bill is now once again $4000.

With the insurance model, two problems occur. The bill doubles and the services are cut in half. We are left with skyrocketing healthcare costs and plummeting access. Exactly the problems which the average consumer is now facing, and these problems are getting worse daily. There is no end I sight for this problem. According to LendingTree, 45 percent of Americans either have or have had medical debt. For millennials age 26 to 41, 30 percent have medical debt.

According to the Commonwealth Fund, 41 percent of working-age Americans, or 72 million people, have medical debt problems or are paying off medical debt. If you add the 7 million elderly adults who are also dealing with these issues, a total of
79 million Americans have medical debt problems. The other problem is the loss of adequate health insurance. More and more people simply cannot afford the ever- increasing premiums.

I have serious doubts about finding remedies any time soon. The Centers for Medicare and Medicaid Services (CMS) follows the insurance model and is unlikely to consider any other models of healthcare delivery or recognize other models which might work better. CMS would have to care about access to healthcare to seriously explore better models for healthcare delivery.

CMS administration gets paid no matter what kind of mess they create by following the insurance model. We don’t know how much money is spent on administrating any insurance policy or HMO, including CMS. We do know that the Chief Executive Officer (CEO) of CVS is paid over $22 million a year. Salaries like this are an insult to the large portion of the U.S. population which has no access to healthcare. We should not have to sell our houses or use up our life savings to get the healthcare we need.

Those without access to healthcare have little choice but to rely upon Dr. Google. A lot of consumers are criticized for going to the web to get answers to their health problems, but why are we blaming the consumer when we should be looking at the real seat of the problem, lack of access to healthcare. Blaming and punishing the average consumer or doctor is so much easier than fixing the problem.

Another access problem is getting enough time with your physician to get answers to your questions. Because your physician’s time with patients is so constrained by hospital and clinic employers, it is not uncommon for your doctor to have already made up his or her mind before you are seen. Your doctor spends little or no time talking with you about your symptoms, much less answering your questions. Dismissiveness, although not new, seems to be taking on a life of its own.

For example, if you come to the hospital or the doctor’s office with a complaint of fatigue, you are likely to be sent home without adequate testing or a correct diagnosis. Your provider has already decided that you have nothing wrong with you requiring treatment. But many conditions cause chronic fatigue, including kidney cancer. Discounting the other causes of chronic fatigue without testing you patient is bias.

In April of 2023, Kira Johnson died in the hospital several hours after she delivered her son. Her husband said he had repeatedly called for help because his wife was bleeding internally, but his pleas for help were ignored. In the eight or ten hours the doctors had to prevent Kira’s death, all they would have needed is for one doctor or one nurse to say, “Hey, what’s happening here?” There must have been several doctors and half a dozen nurses who could have intervened. Why didn’t they? Well, we’re back to dismissiveness. I can tell you from experience that it takes 30 seconds and an open mind to evaluate a post-operative emergency patient.

All providers and nurses should be trained during residency to accurately assess post-op patients. Plus the doctors and nurses need to have the time to perform that
30-second evaluation. Good luck squeezing more procedures into a day already overly packed by hospital administrators with exceedingly complex and ineffective electronic medical records systems which intrude into your doctor’s time to actually talk with you.

So what can you do if you feel as if your concerns are being dismissed? What you do about missing information depends upon your circumstances. For example, if you feel your baby isn’t moving as much as it was and you go to labor and delivery to have your baby’s movements checked, the nurses may tell you everything is fine and tell your to go home. If you feel there really is a problem, you should probably see a doctor. Some women can go in three or four times concerned about their baby’s lack of movement, and some of these women will once again go back to labor and delivery with a dead baby. If you have any concerns about your baby during your pregnancy, ask to be seen by a doctor, preferably your own.

On your first prenatal visit, you should have received a phone number from your doctor and be able to call that number at any time day or night and reach a doctor, specifically your doctor if you are lucky. Ideally, the doctor should then meet you in the hospital and review your baby’s fetal heart rate pattern along with your uterine activity.  

We wrote the book Pregnancy Your Way: Have a Safe and Happy Birth to fill the gaps in the today’s prenatal care model. Our book helps women learn what to watch for in pregnancy and when to call their doctor. This may seem a simplistic notion, but in our current healthcare system, finding information can be a daunting task. Every chapter of the book has real stories about how my patients worked with me to solve problems encountered during pregnancy. Our book lets moms and dads know that they are not alone with their concerns and provides advice on how to manage pregnancy for the best long-term outcomes.