“You Can Choose Your Doctor”-HAH!

In the current debate over Obamacare, the Republicans keep emphasizing an issue which is irrelevant to those of us in rural areas- the ability to choose a doctor.

Paul Ryan seem to think that those of us outside the major urban areas actually HAVE a choice. Most of us don’t.  I’ve been waiting since January to see an orthopedic surgeon here and won’t see him/her till May. By that time will my January MRI even be useful?

And for the record, when I DID live in the  Bay Area and was on Blue Shield, I did NOT pick the best doctors.  I picked the only doctor in town who was treating allergies with steroid shots.  Bad pick.  Eventually,   I got on Kaiser and spent 25 years on it.  No “doctor choice” unless you absolutely loathed your doctor, but I got excellent healthcare anyway.  Once I moved back here,  I was on Health Net (“Hell Net”) and Blue Shield but the choices kept shrinking.  Now I’m on Medicare, and will be going to Eureka Family Practice for the rest of my life, I guess, because who else is taking new patients?  Up here you’re lucky to HAVE a doctor; shopping around is a fantasy.

Someone tell that to Paul Ryan.

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12 thoughts on ““You Can Choose Your Doctor”-HAH!

  1. We live in a backwater, lots of us by choice. Our pool of physicians is shrinking due to retirement of long-term docs, failure to recruit and retain qualified candidates and the upheaval in the healthcare environment over the last ten years. That means that we have difficulties getting appointments with our existing doctors due to their increased patient loads; specialists in our area will either burn out because s/he is the only provider in that specialty or if there are multiple providers in that field they can’t make a decent living AND pay back student loans; we are competing for fewer available appointments because there are too few doctors; and overloaded doctors cannot possible manage their patients’ cases in a meaningful way because they don’t have down time to review patient records, follow-up on tests, new medications and outcomes because they always have a patient sitting across the desk. This doesn’t mean that we have bad doctors. It means, for example, that 4 or 5 cardiologists cannot adequately serve a population of 150,000.

    If, by chance and circumstance, I had been in Eureka when I had a medical issue following my heart attack and triple bypass surgery, I am confident that I would have been dead within six weeks. Fortunately, I was traveling and airlifted to a major medical center in another state where I spent nearly a month in Intensive Care. I was peppered with questions by cardiac specialists starting with “You know you should be on the heart transplant list, don’t you?”; “Why don’t you have an ICD (an internally implanted cardiac defibrillator) because you are at very high risk of sudden cardiac death?”; “Has your cardiologist mentioned any of these subjects to you?”; “Do you know that your life expectancy is maybe a year, or even less?”. And when my very attentive cardiologist in this major center called my Eureka cardiologist to discuss my case, he refused to speak or make himself available with my now attending team, before I left that hospital, I had an ICD implanted, was placed on the heart transplant waiting list and had a written action plan in my hand. I also had personal cell phone numbers, office phone numbers and home numbers of each of the docs on my team.

    I returned to Eureka and fired my cardiologist. His excuse was that he personally had to manage 5,000 patient cases and it was impossible for him to do so – he couldn’t call long distance to my attending cardiologist in a different state while I was lying flat on my back, IVs in both arms, my internal organs acting up due to the stress my body was under, a feeding tube in my shoulder, a breathing tube down my throat and a drainage vacuum tube down my nose and threaded down my esophagus into my gut?

    For the next year, I flew out of state to my new cardiac team for evaluation and treatment about every 2-3 months. Ultimately, with my concurrence, I was transferred to Stanford where I received my new heart about six years ago.

    I can say that, without a doubt, had Fate not taken me out of state where I was stricken with my secondary cardiac issue, I would have been one more cardiac mortality statistic in Humboldt County. Not bad doctors; just over worked to the point of burn out. Doctors attempting to manage cases in this kind of environment kill patients. The plus for a doc in this situation means that s/he makes good money; negatives often result in broken marriages and families; inability to really know their patients; inability to keep up on new and developing technologies and procedures because they are either too busy or too fatigued to do so; and failure to refer promptly to out-of-area specialists.

    We have the best medical professionals in the world and we are making advances for the treatment of new as well old disease. Who pays for what and who gets paid for what needs to be changed, until patients have some skin in the game financially, until the government steps out of the equation, prices will not come down because if the disconnect between the patient and doctor, the disconnect between doctor and hospital and insurer and the disconnect between the insurer and patient are not fixed, we’ll continue to produce poor patient outcomes, physicians will not be appropriately paid and the financial arrangement between doctor and patient will continue to be an elusive goal.

    Just remember, Humboldters, we are fighting one battle because of our geography and the other battle is systemic nationwide – the utter failure of well defined roles by each of the stakeholders in the equation.

    I was one of the lucky ones who somehow survived my initial heart attack and was treated by a Eureka-based cardiology practice. Sadly, my younger brother did not survive when he died at age 52 (treated by the same cardiology practice that I used – he died just two weeks before I experienced my heart attack). Nor, four years after my heart transplant did my daughter survive who died of a heart attack at age 38. Needless to say, I travel to Stanford about every 2-3 months to consult with my cardiologists and transplant team and cannot even consider being treated here because if/when I can get in to see a local, the doctors’ unfamiliarity with heart transplant patients is slim to none.

  2. The only truely affordable healthcare is Direct Primary Care through the Association of American Doctors & Surgeons. They buy all their needs at wholesale prices, then charge the patients only 10% above costs. This means your normal $150.00 care goodie only costs you a buck fifty. Their expensenes are paid from their Subscription services instead of prescription bonuses. It is just like Netflix concept.
    https://m.youtube.com/watch?v=KrGKfollEd0

  3. Exactly right. The older I get the more I feel the need to move to a more urban area mainly for the access to health care, and the availability of Kaiser would be the high in the decision process.

    • The closest access to Kaiser is Santa Rosa. One of my relatives bought a half-million dollar house there recently and she’s having to spend months fixing it up. To me it’s not worth it.

      • All of the Bay Area is overpriced. An alternative is Sacramento with not only Kaiser but UC Davis Medical Center as well. The area around Campus Commons is particularly attractive and not much more than Eureka or Arcata.

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