The U.S. health care system is pretty good at the complicated stuff. A perceptive practitioner can suss out what’s wrong with us or pass us along to a specialist. Blood tests, imaging and now genetic studies can pinpoint what has gone awry, and the medical community is getting better and better at finding a cure or prolonging life at a level worth living.
Where our health care system falls short is on the preventive side. The easy stuff. We know what it takes to give each of us our best shot at a long and healthy life. A balanced diet, more plant than meat. Regular exercise. No smoking, no drugs, limited alcohol intake.
This is not all that complicated were it not for the fact that people are people. Wander the aisles of a supermarket and you will find far more liquor, soda and salty snacks than fresh fruit and vegetables. Carbohydrates are cheap, filling and quick to prepare. And after a day at work intermingled with shuttling the kids here and there, who wants to take a walk?
Once upon a time, health care consisted of incantations and potions from available plants. Gradually science intervened, sometimes documenting the efficacy of those potions and regularizing them into fixed formulas at specific dosages. Doctors were trained at increasingly sophisticated medical schools, and technology grew alongside them. Together, a physician and current technology can work miracles.
But something is missing. The doctor who would make a home visit is largely a thing of the past, though some are trying to revive that practice. It is not cost-effective to have docs running around the community seeing patients in their homes. Public health nurses took on that role in specific cases, visiting newborns or the elderly at home, bringing care and comfort to new families and homebound seniors.
Even that is being carved away. In Maine, the previous governor stripped funding from public health nursing and district coordinating councils that provided resources for local health programs (obesity, addiction, tobacco use) and emergencies such as contagious disease outbreaks.
Now patients are being seen almost exclusively in doctor’s offices or clinics, and increasingly in emergency rooms. An essential ingredient of health care, continuity of care, is missing. There is continuity of care when it comes to your medical records, which can easily follow you from provider to provider and hospital to hospital. It is the continuity of a provider that is sorely lacking.
Even after home visits vanished, we usually had a family doctor to whom we entrusted our care. You might have seen the same provider for your care as an adolescent through adulthood, through your pregnancies, your post-partum care and then taken your children to the same doctor.
Even if you saw different providers for those differing stages of life, you most likely saw one provider in each one of them; now, not so much. The legendary docs of yore who managed, if not delivered, all your health care needs are gone.
Now, go to the doctor’s office and you may see any one of the “partners” who practice there. If you need to be admitted to hospital, you will see the “hospitalist,” a doctor who covers in-house patients so the generalists don’t have to interrupt their office visits running over to manage an admission at the hospital.
Yes, there is communication among all these providers, but it is not the same as seeing the face you know and trust come through the door of your hospital room saying “What’s going on?” The doctor to whom we have entrusted our deepest secrets is no more. Now, as we wonder if those secrets are relevant to our current health problem, we have to consider repeating them to someone we have never met before.
A doctor who skims through your medical record for the salient points that will give him or her a starting point for your care is not the doctor who knows your history without having to look it up, who knows your kids’ names, where they are in college and how you and your spouse are getting along.
To a doctor, those are not social details. They are an essential component of your treatment. They get at your psychological wellness, your ability and capacity to follow medical care instructions, your very will to live.
Now that we have become widgets in a health care system rather than patients with an ongoing relationship with a provider, much is lost. The rotating cast of providers in a doctor’s office or a hospital may be competent, but they are no substitute for a family doctor who knows you and yours. Efficiency is important in controlling health care costs, but effective health care comes from providers who know their patients.