Why did you end up in the ER in the first place? If you’re lucky enough to have a primary care doctor, they probably couldn’t see you for at least a week or two because they’re too busy. By busy, I mean filling out prior authorization forms - the bureaucratic stranglehold of the health insurance companies is immense. If you had abdominal pain the primary care doctor could easily order labwork and a CT scan and treat you outside the hospital - but now every CT scan is denied as a matter of fact - the only way to get it approved is an x-ray first, or an ultrasound, or getting the labs done, then a series of byzantine forms and “peer to peer” conversations with someone who is probably a retired psychiatrist and has no medical knowledge whatsoever and will lose their job if they let too many CT scans get approved. Easier just to say “go to the ER” and wash ones hands.
When I say lucky enough to have a primary care doctor, that’s because they’re all quitting. Due to the politics of covid, trust in the healthcare system and physicians is at an all time low. Patients yell, they are demanding, they are untrustworthy. 50% of the workload of a primary care physician is filling out spurious sick notes for work, for school, accommodation letters for the clinically lazy, emotional support animal letter requests, FMLA, short term disability, long term disability, etc. the bureaucratic nonsense is never ending. The “my finger hurts why is that I want an MRI” messages in the inbox are never-ending. The mental health crisis always makes its way into the primary care doctors office or the ER.
There are many failing institutions in the U.S. that are failing or have failed: the family structure, the system of employment for anyone with a low I.Q., the war on drugs, the criminal justice system. All of these failures lead to broken human beings who eventually end up at their PCP’s office or in the emergency room. One lonely night in the ICU as a trainee I realized the majority of our beds were taken up by hardcore alcoholics withdrawing to the point they needed to be put on a ventilator and sedated into a coma.
Doctors are also considered prey by the legal system. Patients are looking to sue and win the lottery. Our education system produces too many hungry lawyers. They are looking to get lucky, your medical malpractice insurer is looking to settle - it’s cheaper. The big scam now is that your malpractice insurer has the authority to settle with someone suing you without your permission. When you settle you get put in a national database of doctors who settled, your reputation is tarnished.
Why be a primary care physician? You are a tool of the health insurance companies. You get 15 minute visits (5 minutes in reality), unreasonable “metrics” with the only goal being decreasing compensation. Patients feel shortchanged, the medicine you practice is hurried, unsafe. Your inbox fills up with endless requests, the paperwork piles up, you get ever more burdened, and tired, and underpaid. In this endless grind if you make a mistake you will get sued. We are taught in medical school not to prescribe antibiotics needlessly as it harms people, but in reality that’s what patients want and now you get a customer feedback metric, which incentivizes hurting people.
It’s simply impossible to practice medicine in an ethical manner. It’s the same for allied health professions like nurses, lab techs, pretty much everyone except for the health insurance company execs who profit. Don’t get me started on the revolving door between the FDA and pharmaceutical companies. We get to pay for drugs like aducanumab that don’t do anything but bankrupt the system, but the officials who approve this corruption will get nice private industry gigs in a few years on the down low.
There is so much wrong and so much corruption at this point, the examples are endless. I could literally write a book on all that is wrong. But I don’t have to. The system is collapsing in real time. The next time you get sick, or a parent needs to be hospitalized, or someone you love gets cancer, you’re going to learn what the collapse of civil society means. Things are getting worse and worse and one day you will look around and wonder what the hell happened? Where did all the responsible adults go? The doctors pretend to care, the insurance companies pretend to pay, the hospitals pretend to be open, the drug makers pretend their drugs work. It’s all rotten from top to bottom.
Can we fix the U.S. Healthcare system? My opinion is no. There are too many interested parties and too much bureaucracy, and their goal is not the only goal that matters - taking care of patients. It will collapse and be replaced out of necessity by something that can do what it claims to do.