When we talk about bad healthcare, we’re normally talking about one of two things: price or quality.
But Sarah Kliff, writing for Vox, identifies a third way the American health care system exploits and mistreats patients: by taking advantage of their time.
Physicians, specialists, clinics, pharmacists, and hospitals in the US all tend to function independently of one another. In part because of that de-centralised setup, they tend not to share patient data with one another very well.
In other words, all the professionals you encounter as you move through the healthcare system aren’t responsible for coordinating or communicating with one another. That’s largely left up to you, the patient.
That means each of us is burdened with the time-consuming and stressful task of coordinating our own care in a system that’s often maddeningly complex.
Kliff gives a personal example of the strife this can cause:
Last December, a doctor told me to get an MRI and see him again three weeks later to go over the results. I wanted to scream, “Do you understand what it’s like to schedule an MRI?”
I did — I had done it three months earlier. I knew it would require his office putting together a justification for the scan and sending that to my insurance company. That usually took a few days or a week. Then the insurance company would need to pre-approve the scan. That usually took a week or so — and another few days before I received a letter notifying me of the decision. Only then could I schedule the procedure.
But for my doctor, getting an MRI was simple — he just had to ask me to do it.
Patients, she shows, largely get stuck managing their own care. That can be a full time job, and one they may not be very good at.
What’s more, doctors aren’t measured on or held accountable for the amount of work their patients have to do. Meanwhile, it’s in their interest to offload as much of that work as possible onto patients, because it saves them from having to hire additional staff to coordinate patient care.
That’s a problem: Patients have lives outside of their doctors’ offices. They have jobs to do and children to take care of. I’m lucky that my job comes with flexible hours. I can shoot off emails to my doctor’s office and wait on hold, at my desk, without fear of getting fired. Last Thursday I spent 90 minutes waiting to see my doctor, right in the middle of a workday, and my boss didn’t bat an eye.
Not everyone has this luxury. Some have to make a choice between doing their actual work (which pays the bills) and their patient work (which doesn’t). In those cases, prescribing health care with a high patient work burden can be equivalent to denying health care. Medication won’t do much to help a condition when you don’t have the time to make the phones calls necessary to track it down.
There is a risk associated with not measuring patient work: namely, that patients will give up when life gets in the way. This is an especially acute worry for lower-income patients, who often work for hourly wages and have little space to change their schedules.
If the health care system is going to improve, a big part of that will likely involve getting doctors and other providers to actually communicate with one another and offload work from stressed-out patients. That may mean hiring people to coordinate patient care, or paying providers (many of whom are overworked themselves and can’t bill for “coordination”) to do so.
But without a solution, patients who cannot afford to do this work for free will likely continue to fall through the cracks.
You can read Sarah Kliff’s full story at Vox.