Friday, April 18, 2008

Why are patients in the US so unhappy ? ( and what we can do about it)

There used to be a time when rich patients from India would fly to the US to get medical care at Mayo Clinic and Johns Hopkins. The US still has these world- class centers of medical excellence, but the average patient in the US is unhappy ! The US is the world's richest country and spends gadzillions on medical care ; it boasts of some of the world's best doctors and hospitals - and yet most patients ( and their doctors) are unhappy with healthcare. Why is this so ?

There are many problems; and these include:

1. High costs of medical care, partly because of overtesting, ( imaging companies want to sell their latest scanners , gadgets and gizmos); and overtreatment ( because greedy pharmaceutical companies want to sell their newest ( and most expensive) drugs).
2. Too much paperwork, because of a bloated bureaucracy. There are more medical administrators and paper-pushers than there are doctors in the USA !
3. Poor insurance coverage, because of high costs
4. Rushed doctors, who do not have enough time to spend with the patient, because of the quotas they need to fill, set by the hospital administrators
5. The threat of lawsuits for negligence, which forces doctors to practise defensive medicine and spend more time on documenting care rather than on providing it !

With such a long list of problems, how do we find a solution ? The issue seems too complex , especially when you realise that healthcare costs over a trillion dollars in the USA today.

I feel the real reason for this unhappiness is far more basic. We need to remember that while policy analysts and Presidential candidates love to talk about the "healthcare industry", for most of us healthcare means the one-on-one interaction we have with our personal doctor. This is the heart of all healthcare - the doctor-patient relationship - and this is what we need to improve if we want to correct the present situation.

The rule is simple - unhappy doctors make for unhappy patients - and happy doctors create happy patients. ( Incidentally, the obverse is equally true , in that happy patients make for happy doctors !)

If we want to have happy patients, we need to create happy doctors - doctors who enjoy looking after patients, and have fun taking care of them. If we start from the bottom-up, and then work upwards, we can solve the problem ! It's just a question of improving these "moments of truth" which occur daily in the doctor's life - and which have such a profound impact on the patient's well-being.

If we treat each doctor as just another expensive employee; or a "healthcare worker" ; or a
" skilled professional" with a special skill set, we'll never be able to tackle the problem. However, if the entire industry learns to treat each individual doctor with the same respect and care with which each patient treats their personal doctor, I think we will be able to make progress !

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