Years ago, when you visited a doctor, they would spend whatever time was needed to figure out your problem. While not a perfect system, most of us thought of our doctor as not only someone who helped us in times of trouble but also someone we could rely on and trust.
Some of us may have been placed on a blood pressure medicine or another medication and would be managed simply by their doctor, A specialist who may have been required if the problem was beyond the skills and knowledge of our primary doctor. It was not unusual for a primary care doctor to spend as much time as necessary to help, and much less time on paperwork, protocols and worrying about being paid by insurers. It was a simple system of trust, relationships and you.
Today, it is quite different, with most doctors having a lot to worry about and it is unusual for a primary doctor to spend more than 10 minutes with you. The relationships people remembered are mostly a thing of the past, and many people rightfully question their doctors needs for tests as they pay more of the bill.
Today’s healthcare system includes physician extenders such as nurses, PA’s and other people who spend their day getting approvals, making referrals and moving us through their offices which have become the gateway to a system that looks at us as parts that malfunction rather than holistically, which is how the body functions.
Doctors referrals add up to more costly tests which are first pre-certified and then paid for by the insurers. Often, the tests are negative and the musculoskeletal system is largely ignored, even though it can often be the reason for the symptom.
Insurers are not helping the situation by adding high deductibles, for necessary interventions such as chiropractic or other sorts of therapeutic treatments and would rather pay more for testing than for possibly curative conservative treatments. Physicians routinely recommend medications from big pharma, especially in the elderly populations. Provider networks have gotten smaller as more physicians say no to starvation level reimbursement policies while insurers continue to raise your premiums year after year.
The change in how primary care operates is less about the patient and more about moving them through this broken system. Insurers under Obamacare have made more money as they pushed up the cost of care, and they have been happily accommodated by the large hospital systems that have grown larger through tiers and other non competitive systemic changes.
This has resulted in American’s using more drugs than any other country in the world as well as a high priced system that according to the WHO results in less healthy outcomes. The Opioid crisis has been a side effect of our system and the elderly are often in worse health as they become dependent on multiple medications that often interact in ways that affect their mental status and require hospitalizations from their side effects.
Recently, NBC news looked into the drug epidemic which has hit our elderly the hardest.
Michelle Chen For-profit medicine incentivizes overmedicating our elderly rather than caring for them
Denying seniors humane care deprives all of us of the right to age with dignity
As the “gray wave” of aging baby boomers crowd into the country’s creaking long-term care system, many of them may unexpectedly end up in nursing home where anti-psychotic medication, rather than comprehensive social and mental health services, have become a standard way for some residential institutions to maintain order.
Yet, according to human rights investigators, anti-psychotic drugs are often administered to residents not with a doctor’s prescription, but the management’s. So-called “chemical restraints” have become a routine “fix” for behavioral problems, such as those who “resist” staff’s orders, or for dementia patients with a habit of wandering off. In reality, deliberately over-medicating elderly patients is not designed to help them as much as to help an overwhelmed workforce of clinicians struggling to care for too many patients with too little time and funding.