Doctors Say Current System Impedes Medical Care
Today, President Obama told the American Medical Association that the health care system costs too much, includes too few people and is unsustainable without major changes.
"But what I refuse to do is simply create a system where insurance companies have more customers on Uncle Sam's dime, but still fail to meet their responsibilities," Obama says.
Many doctors agree that lack of health insurance is a big problem. But their day-to-day concerns also include a lack of time with patients and a system that has evolved into a confusing web of paperwork.
Dr. Nancy Nielsen, president of the American Medical Association, says the biggest problem is when patients don't have health insurance.
"Every study that's been done has shown that people who lack health insurance don't go to the doctor for preventive care — they delay care," she says.
Nielsen says doctors face other challenges as well, such as coordinating care when patients' insurance plans limit the choice of doctors and hospitals. Doctors often have to pick drugs off a list of covered pharmaceuticals. And they are trying to incorporate health information technology systems into their practice, without assurances that the systems they are buying will be able to exchange information with other systems.
Family physician Richard Roberts has been practicing in tiny Belleville, Wis., for 23 years. He says the health care system's biggest problems are its complexity and that not everyone is covered. He describes a mother who brought in her young son for an ear exam. Roberts noticed she didn't look happy, so he asked her what was wrong. Further questioning revealed that she had depression, and that her husband had started drinking. Roberts spent some time counseling her, but in the end could only bill for the 15-minute ear exam.
Roberts is most troubled by what has happened to the doctor-patient relationship.
"We don't structure our health system to support that," he says. Patients jump from health plan to health plan and have to switch doctors. Physicians are paid to do procedures, not to talk to people.
But talking with patients is a vital part of being a doctor, says Roberts. "That's the real joy of what we do. That's the insight that allows us to do our work," he says. "If we can redesign the system to support that, not only will people be happier, but the costs also go down because more appropriate things get done."
Time Spent On Paperwork, Not Patients
Roberts is also disturbed by what he calls "administrivia." He estimates that he spends 15 to 20 hours a week filling out forms — Family and Medical Leave Act forms, disability forms and insurance forms, though he says that in Wisconsin the insurance forms aren't too bad.
Oncologist Robert Fein in Somerset, N.J., says things for him are getting worse week by week. "I think the health care system is ready to implode."
Oncologists used to be paid significantly more than it cost them to buy chemotherapy. In an effort to reduce costs, both the government and insurers have substantially cut back on what they pay for chemotherapy. Fein says he sometimes gets paid less than it costs him to buy chemotherapy, and in addition, more and more patients aren't able to pay the co-payments, leaving him stuck with the balance.
He tries to help his patients by helping them apply to drug companies for free or discounted chemotherapy drugs. But that puts him in an awkward position with his patients.
"I am now having to ask many of these patients for their tax returns so I can fill out paperwork so they can get alternative coverage for their drugs. I'm a physician, I'm not an accountant," he says. And this isn't what he studied in medical school.
Many Delay Care, Escalating Illness
For emergency room doctors, one of the big problems with the current health care system is the recession.
"We're seeing newly uninsured patients. We're seeing patients who as they get into greater financial distress are cutting corners and delaying the care that they need," says Arthur Kellerman, professor of medicine at Emory University. He works in the emergency department at Grady Hospital in Atlanta and sees patients who have delayed getting treatment for too long.
"By the time they come to us, they are in legitimate emergency condition with problems that are far more costly and sometimes impossible to treat. And that's heartbreaking," he says.
Kellerman has seen patients with advanced cancer, heart attacks and with strokes that could have been avoided with earlier care.
In Wisconsin, Dr. Roberts says the health care system has to change — soon. "It's beginning to collapse of its own stupidity," he says.
But how should it change? He won't say.
"The debates about whether it needs to be single-payer or multipayer, I'm going to leave that to the politicians ... I just want to get it done and have everybody covered."
And, Roberts wants to go back to being a doctor full time.
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See NPR's Julie Rovner's live blog of President Obama's speech to the American Medical Association.
ROBERT SIEGEL, host:
As we just heard from Scott Horsley, one of the biggest applause lines today was the president's vow to let doctors be doctors, not bean counters. Doctors may not agree with each other or with the president on the details of a new health care system, but as NPR's Joanne Silberner reports, they are fed up with the current system.
JOANNE SILBERNER: Nancy Nielsen, head of the American Medical Association, says that one of the most frustrating things for doctors is dealing with people who lack health insurance.
Dr. NANCY NIELSEN (American Medical Association): That is a problem, because every study that's been done has shown that people who lack health insurance don't go to the doctor for preventive care. They delay their care. They wait until it's late.
SILBERNER: And they come in sicker and harder to cure. Family physician Richard Roberts misses the old days, when doctors were paid more for spending time with patients. He's been practicing in tiny Belleville, Wisconsin, for 23 years. He says health care is about relationships, about a patient going to a doctor for help or advice or assistance.
Dr. RICHARD ROBERTS (Family Physician): We don't structure our health system to support that. In fact, we do everything possible, it seems to me, in the way that we have patients jumping health plans one year to the next, and consequently maybe having to change doctors one year to the next, the way that we pay physicians - we reward them for doing procedures and not necessarily getting to know people. Those are the things that doctors are grieving.
SILBERNER: And in his speech today, President Obama grieved them, too, though some specialists fear for their autonomy and their pocketbooks if the system changes to favor more talk and fewer tests. One change all doctors would welcome is less paperwork. Roberts estimates he spends 15 to 20 hours a week on what he calls administrivia - filling out disability forms, medical leave forms, insurance forms.
Oncologist Robert Fein of Somerset, New Jersey, has paperwork problems, too. Some of it comes from his efforts to help patients get free or discounted chemotherapy from drug companies. He's been sending in forms for them, forms that require that patients attest to their income.
Dr. ROBERT FEIN (Oncologist): I am now having to ask many of these patients for their tax returns so I can fill out paperwork so they can get alternative coverage for their drugs. I mean, I'm a physician. I'm not their accountant.
SILBERNER: He says this is not why he went to medical school. And the recession is making the situation worse for those uninsured patients the AMA's Nancy Nielsen worries about. Emergency physician Arthur Kellerman works at Grady Hospital in Atlanta.
Dr. ARTHUR KELLERMAN (Emergency Physician, Grady Hospital): We're seeing newly uninsured patients. We're seeing patients who, as they get into greater financial distress, are cutting corners and delaying the care that they need, sometimes until it just becomes so bad that they can't put it off any longer. And by the time they come to us, they are in legitimate emergency condition with problems that are far more costly and, in some cases, impossible to treat. And that's heartbreaking.
SILBERNER: There's a patient he can't get out of his mind: a woman who went to five public clinics trying to renew a prescription for blood pressure medication.
Dr. KELLERMAN: Now, her blood pressure was dangerously elevated. It had took her five days, in a system that spends more money per person on health care than any other nation on Earth. That's just outrageous. It's stupid, and surely we can do better than that.
SILBERNER: Stupid is a word you hear a lot from doctors, family physician Richard Roberts, too. He says the health care system has to change soon.
Dr. ROBERTS: It's beginning to collapse of its own stupidity.
SILBERNER: But Roberts, for one, won't say how he wants it to change.
Dr. ROBERTS: You know, the debates about whether it needs to be single-payer or multi-payer - I'm going to leave that to the politicians and the economists to hammer out. From my vantage point, I just want to get it done and have everybody covered.
SILBERNER: And he says what a lot of physicians and surgeons say: He just wants to go back to being a doctor full time.
Joanne Silberner, NPR News. Transcript provided by NPR, Copyright National Public Radio.
