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  1. Health wonk review , in our place that i don’t like to name it, the cause of so much problem is, when people are in the emergency room, instead of medical attention right away , they keep on asking about what happened or some foolish interview. i hope that the government should do something about this kind of problem.

  2. To return to standard way of delivering medical care that I was taught in medical school, we should eliminate the licensing of physicians by state run medical societies. All physicians should be licensed by a central national agency. In order to keep their licenses physicians would be required to see patients who call their offices promptly, and in a place that is appropriate, depending on the urgency of the situation.

  3. How to better fund the health care and see that everyone is covered by some insurance.
    The arguments will rage over the best way to pay for the costs, but no matter what is finally agreed upon, it will not improve our care or lower the costs until the real problem is addressed.
    The real problem lies not with the way health care is funded, though all would agree there is room for improvement. Rather, it is the way healthcare is delivered on a day to day basis on the front lines. Drastic changes are needed in the way patients are treated when they are ill and in need of immediate help. The delivery system that has developed is so unwieldy and cumbersome that it not only makes for bad care, but directly causes the tremendous increase in costs. In short, the way medicine is practiced today is broken and in urgent need of repair. Until this problem is addressed and improved, funding and methods of insurance payments will be of no benefit.
    What happened to me this past summer is I believe typical of the way medical practice has deteriorated in the past several decades. While vacationing in North Carolina I develop a cardiac arrhythmia. It consisted of extra beats, a condition I had had before, but because they were more frequent, I decided to seek medical care in the middle of the night.
    I called the office of the only cardiologists in town and was told by the answering service that I would have to go to the local hospital emergency room for care. This advice was given without allowing me to speak with the doctor on call and explain my symptoms. I had no choice but to go to the ER at the local hospital where I was seen by an Emergency Room physician. After examining me, he called the same cardiologist that I had tried to contact earlier and was able to talk to him personally. Rather than coming to the ER to see me, the cardiologist told the ER physician to admit me to the hospital and he would see me the next day. .I was admitted and cared for by a second physician, a hospitalist, or full time physician working in the hospital. This physician ordered several very expensive cardiac tests before I was ever seen by the cardiologist. The next day the cardiologist saw me and could find no evidence of intrinsic heart disease, but nevertheless the expensive cardiac tests had already been performed. He discharged me and said I was to see him in his office after two weeks.
    If the cardiologist had answered my original call, he might have made arrangements to see me in his office or in the hospital as an out patient and avoided the cost of the ER visit and care as well as that of the two other doctors
    Several days after discharge i had a recurrence of symptoms but not as bad as before. I went to the office of the cardiologist who had cared for me in the hospital and was told by the nurse that I could not be seen because I did not have an appointment. She refused to even tell the doctor that I was there in the office. Instead I was advised to return to the emergency room if I wanted more medical care. Since I did not feel too bad, I went back home
    This episode probably cost Medicare and my supplementary insurance up to ten or fifteen thousand dollars not including the fees of the physicians. I received adequate but not exceptional care.
    In the United states, 26% of people needing immediate health care must go to an Emergency Room because they cannot gain access to their physician. This is because physicians set up their practices to see patients from 9-5 and by appointment only. Thus patients are required to go to an ER if they are sick and do not have an office appointment or if it is after normal office hours. ER visits are at least 20 to 50 time more expensive than office visits. The problem with health care costs is not the funding but this type of delivery that is driving up costs and needs to be fixed.
    To return to standard way of delivering medical care that I was taught in medical school, we should eliminate the licensing of physicians by state run medical societies. All physicians should be licensed by a central national agency. In order to keep their licenses physicians would be required to see patients who call their offices promptly, and in a place that is appropriate, depending on the urgency of the situation. If a patient needs to be seen at the Emergency Room, then the physician of record must meet the patient there and administer care. The hospital could charge a nominal fee for the use of an examining room but no more.
    If a physician refuses to see a patient in need of care or merely refers them the ER they should lose their license to practice. This would reduce the costs of care enough to allow for the present system to continue and would save billions of dollars in health care costs.
    A. Felman, M.D.

  4. How to better fund the health care and see that everyone is covered by some insurance.
    The arguments will rage over the best way to pay for the costs, but no matter what is finally agreed upon, it will not improve our care or lower the costs until the real problem is addressed.
    The real problem lies not with the way health care is funded, though all would agree there is room for improvement. Rather, it is the way healthcare is delivered on a day to day basis on the front lines. Drastic changes are needed in the way patients are treated when they are ill and in need of immediate help. The delivery system that has developed is so unwieldy and cumbersome that it not only makes for bad care, but directly causes the tremendous increase in costs. In short, the way medicine is practiced today is broken and in urgent need of repair. Until this problem is addressed and improved, funding and methods of insurance payments will be of no benefit.
    What happened to me this past summer is I believe typical of the way medical practice has deteriorated in the past several decades. While vacationing in North Carolina I develop a cardiac arrhythmia. It consisted of extra beats, a condition I had had before, but because they were more frequent, I decided to seek medical care in the middle of the night.
    I called the office of the only cardiologists in town and was told by the answering service that I would have to go to the local hospital emergency room for care. This advice was given without allowing me to speak with the doctor on call and explain my symptoms. I had no choice but to go to the ER at the local hospital where I was seen by an Emergency Room physician. After examining me, he called the same cardiologist that I had tried to contact earlier and was able to talk to him personally. Rather than coming to the ER to see me, the cardiologist told the ER physician to admit me to the hospital and he would see me the next day. .I was admitted and cared for by a second physician, a hospitalist, or full time physician working in the hospital. This physician ordered several very expensive cardiac tests before I was ever seen by the cardiologist. The next day the cardiologist saw me and could find no evidence of intrinsic heart disease, but nevertheless the expensive cardiac tests had already been performed. He discharged me and said I was to see him in his office after two weeks.
    If the cardiologist had answered my original call, he might have made arrangements to see me in his office or in the hospital as an out patient and avoided the cost of the ER visit and care as well as that of the two other doctors
    Several days after discharge i had a recurrence of symptoms but not as bad as before. I went to the office of the cardiologist who had cared for me in the hospital and was told by the nurse that I could not be seen because I did not have an appointment. She refused to even tell the doctor that I was there in the office. Instead I was advised to return to the emergency room if I wanted more medical care. Since I did not feel too bad, I went back home
    This episode probably cost Medicare and my supplementary insurance up to ten or fifteen thousand dollars not including the fees of the physicians. I received adequate but not exceptional care.
    In the United states, 26% of people needing immediate health care must go to an Emergency Room because they cannot gain access to their physician. This is because physicians set up their practices to see patients from 9-5 and by appointment only. Thus patients are required to go to an ER if they are sick and do not have an office appointment or if it is after normal office hours. ER visits are at least 20 to 50 time more expensive than office visits. The problem with health care costs is not the funding but this type of delivery that is driving up costs and needs to be fixed.
    To return to standard way of delivering medical care that I was taught in medical school, we should eliminate the licensing of physicians by state run medical societies. All physicians should be licensed by a central national agency. In order to keep their licenses physicians would be required to see patients who call their offices promptly, and in a place that is appropriate, depending on the urgency of the situation. If a patient needs to be seen at the Emergency Room, then the physician of record must meet the patient there and administer care. The hospital could charge a nominal fee for the use of an examining room but no more.
    If a physician refuses to see a patient in need of care or merely refers them the ER they should lose their license to practice. This would reduce the costs of care enough to allow for the present system to continue and would save billions of dollars in health care costs.
    A. Felman, M.D.

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