Stressed Out System

Stressed Out System

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I saw a patient today and looked back at a previous note, which said the following: “stressed out due to insurance.” It didn’t surprise me, and I didn’t find it funny; I see a lot of this. Too much. This kind of thing could be written on a lot of patients’ charts. I suspect the percentage of patients who are “stressed out due to insurance” is fairly high.

My very next patient started was a gentleman who has fairly good insurance who I had not seen for a long time. He was not taking his medications as directed, and when asked why he had not come in recently he replied, “I can’t afford to see you, doc. You’re expensive.”

Expensive? A $20 copay is expensive? Yes, to people who are on multiple medications, seeing multiple doctors, struggling with work, and perhaps not managing their money well, $20 can be a barrier to care. I may complain that the patients have cable TV, smoke, or eat at Taco Bell, but adding a regular $20 charge to an already large medical bill of $100, $200/month, or more is more than some people can stomach. I see a lot of this too.

Finally, I saw a patient who told me about a prescription she had filled at one pharmacy for $6. She went to another pharmacy (for reasons of convenience) to get the medication filled, and the charge was $108. I could see the frustration and anger in her eyes. ”How do I know I am not getting the shaft on other medications?” she lamented. I told her that I see a lot of this.

Then I started considering how many doctors, nurses, and hospital administrators are “stressed out due to insurance,” and I laughed. I think the number of those not stressed out would be far easier to count. In this blog I have recounted the overall cost the insurance situation takes from my own practice, and my own psyche. I can’t do it justice in a single post, it takes a huge toll on those of us in it. The cost is high.

So what is the overall cost of a bad system? Sure, the system itself uses money poorly and dumps buckets of money on things that have no impact on the health of patients. Sure the system encourages doctors to not communicate, not spend time with patients, and to spend more time with the notes than with the patient. But what is the toll of this toll? What is the toll that simply having an insane system that demands huge sums of cash, yet does not give back a product worthy of that cost? What is the toll of people suspicious that they are being gouged at the pharmacy, hospital, or doctor’s office? What is the cost of having a healthcare workforce that goes home more consumed by frustration about the system than by the fact that people are sick and suffering?

Our system is very sick, and the fact that it is so sick makes me sick. It makes a lot of us sick.

I see a lot of that.

PREVIOUSLY by the same author on THCB:

“The Cost of Fear”
“Dear Mr. President”

ROB LAMBERTS is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at Musings of a Distractible Mind, where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player.  He is a primary care physician.

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86 Comments on "Stressed Out System"


Guest
Jun 19, 2013

Stress even affects ones fertility. What do you suggest to combat stress while planning a baby.

Guest
TD
Mar 19, 2010

Would someone please explain to me how it is that you think the current health care bill will eliminate any stress over health care costs? As I see it, it will simply spread more stress to more people by raising everyone’s premiums.

Guest
Nate
Mar 18, 2010

And how would you deal with the vastly more prevalent situation Sharilyn is describing above?
First by correcting here, she doesn’t have to pay full price. I have never meet a doctor that won’t give a cash discount close to equal to what insurance pays him or better.
Next I would point out that for $10 a month or so she could buy access to those very same discounts insurance companies have.
Next as a business owner myself I would say just becuase you want to be in business for yourself doesn’t mean your entitled to be in business for yourself. She comes off to me as downright selfish. Why should I pay for their choice to own their own business? If he is a half decent driver he could have a job with benefits in 3 ours. Hell I have 2-3 clients that would hire him if his record was half good.
This is the problem with the left, your reform is built on lies and greed. She doesn’t have a problem with insurance she has a problem with the choices they have made and wanting someone else to subsidise them.

Guest
joe queen
Mar 17, 2010

Will Jesus the biggest practicing Doctor of broken souls support a Socialize Health Care?
My Kingdom does not belong to this world, Jesus said many times. We are a Christian Nation that committed horrible sins against native American Indians, Immigrants, and Slavery. Now we institutionalized denying health insurance to the sick. Is this a Christian Act. Is Jesus a for profit savior. Can Christians profit on the poor the insured. Jesus is beyond being a Republican and Democrat. If the Lord wants health care for the poor, he will touch the hearts of all the Congressmen he wants, He is the king, and nothing can stop him not Rush Limbaugh,not Fox News, not Obama nor the Democratic Party, he is the almighty, the omnipotent and omnipresent Jesus Christ my dear and beloved brothers and sisters in Christ. You see Jesus doing miracle in Hospitals, You see him in your operating rooms, he is everywhere and he is with the poor just be humble and remember your Lord and General Surgeon of the world and the United States the Lord Jesus Christ

Guest
Mar 15, 2010

Sharilyn is describing one of my biggest frustrations: I can’t charge what I want. It has to do with Medicare’s rules as well as the contracts we must sign to accept insurance, not the greediness of docs. We cannot discount patients without either breaking a contract or breaking a law. If we discount below what we charge Medicare patients, we are breaking the law.
Gosh, what would fix that….hmm….I don’t think anyone has talked about balance billing yet. If we were freed from the stupid rules that Medicare forces us to follow:
http://distractible.org/2008/05/29/ten-dumb-things-about-medicare/
http://distractible.org/2007/10/30/ten-facts-you-may-not-realize-about-medicare/
http://distractible.org/2009/02/03/dear-mr-president-medicare-stinks/

Guest
Mar 15, 2010

Same way it deals with other people suffering from eating disorders and mental disease.
And how would you deal with the vastly more prevalent situation Sharilyn is describing above?

Guest
Nate
Mar 15, 2010

Curious Margalit how your ideal liberal healthcare system would deal with a person like this?
http://news.ninemsn.com.au/world/1027360/woman-aims-to-become-worlds-fattest
Should insurance companies be forced to insure this women at rates capped at some percentage of those not activly trying to kill themselves?

Guest

I have been reading up on health savings accounts (as implemented by countries such as Singapore). Seems like an idea that could work (at least it does there). But, I am not sure how well it will work in the US. Maybe it’s another alternative. Any thoughts?

Guest
Sharilyn
Mar 14, 2010

My major stress about healthcare is the unfairness of it all … I have been told that patients without insurance have to pay in full the doctors’ charges while insurance companies enjoy paying a much reduced rate … on the average about 30 to 40 % less. I am one of the 48 million without healthcare insurance as we are owner/operators. We just cannot afford several hundred dollars a month for poor quality catastrophic insurance with high deductibles as I have been quoted … we are in our late 50’s and no company insurance available. Repairs/maintenance on our 2000 Volvo truck cost us about $18,000 last year alone, wiping out our savings! This healthcare crisis is a major stress to me as I still have 7 years before I can even qualify for medicare. My husband at least has the VA … I have nothing!

Guest
Mar 14, 2010

I don’t believe it’s true, Nate.
archon, I have no problem with great disparities in wealth. I have a problem with exploitation and unbridled highway robbery. This country proved that it is possible to have a system that serves the wealthy and the citizenry well. I just don’t want to see it go away.

Guest
archon41
Mar 14, 2010

Would you perhaps care to identify some of the countries where, by dint of “regulation,” great disparities of wealth no longer exist? Do you suppose Siemens, Roche, BP, Total etc. to be less focused on return on investment than their American counterparts?

Guest
Nate
Mar 14, 2010

just repeating what I have seen in life. What I will say is it is enviromental and not genetic. I have seen the difference within families, kids of different age groups responding to their friends and what happens around them.
Curious if you don’t have an answer to how to solve it or you don’t beleive it is true?

Guest
Mar 13, 2010

archon, I have no desire to see a postcorporate America, whatever that may be. I hope corporations live long and multiply and all their owners and executives and shareholders become as rich as they desire. I just want their activities regulated so the rest of America, which supplies the means by which they get rich, also benefits from this prosperity. Call it responsible capitalism, if you wish.
Nate, I guess you are pretty much politely rephrasing what South Carolina’s Lt. Governor, Andre Bauer had to say:
“My grandmother was not a highly educated woman, but she told me as a small child to quit feeding stray animals. You know why? Because they breed. You’re facilitating the problem if you give an animal or a person ample food supply. They will reproduce, especially ones that don’t think too much further than that. And so what you’ve got to do is you’ve got to curtail that type of behavior. They don’t know any better.”
I have no answer to that.

Guest
Nate
Mar 13, 2010

besides reading the glossary did you read the rest of the bill? Nothing in there actually does anything, it talks about fraud and the need to do something and studying it but it doesn’t actually DO anything.
For example Medicare and Medicaid lose about 10% to fraud and waste, if goverment is spending 1 trillion now of the 2.5 trillon annually that means they lose 100 billion to fraud. They propose spending 100 million. That is .0001 of total spening, that is a joke of an effort. They aren’t service about fraud they are giving it lip service.
“I don’t think it inhibits insurance companies from steering people to less costly choices.”
Steer them how? Asking nicely? Whats left if you can’t penalize or reward them?
“Both public and private insurers could communicate information about utilization vs. others in the population of comparable age and health status.”
We do this now for groups that are that aggresive in cost containment. We’ll do employee meetings and tell them their generic utilization is low or ER visits are high then discuss alternative options with them, this is usually in conjunction with a change in plan to “reinforce” the change, i.e. higher co-pays or cost sharing, unfortunetly the needed utilizers are penalized with the wasteful spenders.
“This is not a small problem to be resolved by a bunch of community clinics.”
Exactly right it can only be solved by people not having kids they can’t afford. The way you do that is stop with all the handouts and working the parent’s F’n asses off so everyone that knows them says G D I ain’t havin no kids till I can afford them cause it sucks working two jobs to pay mandatory support for my kids. With all the liberal charity and handouts you can live a very easy life with next to no works just by having a couple kids.
Well said Barry

Guest
archon41
Mar 13, 2010

Perhaps Margalit will some day reveal to us her vision of postcorporate America, and how, in the “transformational” era, incomes are to be determined.