By Dr. Bruce Smith ——Bio and Archives--October 17, 2023
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I think the COVID epidemic changed most everything. We’re still trying to sort that one out. Because people were supposed to avoid contact with others, many put off regular healthcare checkups and treatment. Now we’re trying to catch up, making us even more aware of the changes in many of our countries. This new awareness means we see things better than we did before.
These days we’re in a kind of healthcare limbo. The old healthcare system that was the best in the world has been altered, damaged some say, to the point that we regularly question its effectiveness. There might be something better coming along, but we don’t trust the people who promise it, and we don’t know when it is supposed to arrive. It doesn’t seem to be getting better, and that’s worrisome.
All of us are getting older each year, and we notice the effects some years more than others. Medical issues seem to appear more and more, making us wish to return to our younger days when we didn’t think about it so much. Others have been thinking about it, however. Look at the number of people in your high school graduating class who have passed on. The percentages alone are frightening. Looking at a list is more sobering, particularly since we remember them at age 18. Health issues are a growing concern for everyone, it seems.
Lots of people complain about the current system, particularly when insurance companies are involved. Why should a heartless insurance company decide whether I get treatment or physical therapy? On the other hand, why should a politically driven bureaucracy like our government decide whether I get treatment or physical therapy? Why are my choices limited? Why does it cost so much? Some say a single-payer (socialized) healthcare system would be best, but some research into those systems makes it plain that almost no one likes these systems. Where socialized medicine becomes established, people begin to look at former systems with considerable nostalgia.
Healthcare appears to be less and less patient-centered. There are more and more opportunities for healthcare providers to be insulated and distant from their patients. The well-being of medical bureaucracy and medical providers now often comes before patient concerns. The lawyers have been involved in healthcare for a long time, and their influence can be seen everywhere. There are endless forms and releases to be signed and signed again after short lapses of time. At the same time, when there is neglect or incompetence in the system, the system will ignore it or cover it up hoping those involved will forget it ever happened. It works.
As the medical and mental health fields change, it often takes a long time to get into see someone, especially a specialist. And it takes longer still in rural areas. Appointments can be months out and it’s easy to forget by the time it rolls around. For seniors, this waiting can be very worrisome, and there are lots of seniors.
Many have left the medical and mental health fields. This is making the waiting times even longer for many people who need it. COVID, management problems, a growing government presence in health care of all kinds, and the changing needs of an aging cohort all contributed to changing the system, and the changes have not always been for the good. It’s getting worse, and it may get worse still.
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Other problems, often stemming from government or FDA (another medical bureaucracy) policy, have complicated the medical scene. Many medications for managing pain have been severely restricted. In the mental health field, drugs like Xanax, used for managing anxiety, have been restricted as well. Oftentimes there is no guidance for tapering down the dose. This has caused a ripple effect among people who had used them for years prior to the change, sometimes sending them to alternative or even illegal sources. Some medications are cheaper than others. Some medical practices and insurance companies require patients to try cheaper alternatives before being prescribed newer and potentially more effective medication.
Regardless of one’s health or the health system we use, there are some skills that have become essential.
We must be patient whether we are patients or not. After all, when we go to the doctor, it’s our bodies we’re concerned about. They may not be interested, but we are. At the same time, lots of employees at the office are GenX and younger. Don’t expect them to have top line social skills, but be sure to praise them when they do.
We must be vigilant. Bureaucracies exist to perpetuate themselves and keep the people they like employed. They’re also supposed to serve customers or the public or some constituency. When they begin to slack in their duties, it is our duty to remind them what this is all about. They know the routines, but we don’t. We deserve to be informed and treated fairly.
We must be persistent. Bureaucracies keep going because that’s what they do, but an efficient pace isn’t a given. When we know there’s something we’re supposed to have or someone we’re supposed to see, we often have to be the ones to make sure it happens. Most medical offices are part of a larger system made up of other medical offices, administrators, and all those people who get paid for something. The systems do not necessarily get along or coordinate with each other.
We must be rational. We must understand how the system is supposed to work, even when it doesn’t. No one can demand or expect miracles, but there are rules and policies and we must be fair about seeing to it that they are followed. None of us is more special than the others. We need to follow the rules. There are reasons why the wheels turn as they do. Pay attention and take notes. Then there’s a written record to compare to our expectations.
We must be self-advocating. Whether our situation is urgent or not, we must make sure our own interests are looked after. Government and medical bureaucracies may give lip service to their duties to protect citizens and patients, but we have to look out for ourselves. Self-interest needs to be a given. It’s not wrong and it’s not shameful. Free societies value the individual over the group. Each of us is a majority of one. We must be the squeaky wheel sometimes. Everybody before us might have been neglected or put on hold for long stretches, but it doesn’t mean we have to put up with it. Squeaky wheels get noticed, and then something might get done. It’s up to us to hold the system accountable.
We must be able to do some research. Medical knowledge expands rapidly all the time. It’s right to expect medical professionals to be up to date on the latest practices and procedures, but not everyone in the medical profession agrees with each other. There are different points of view in medicine. Part of research might be getting a second opinion. It’s important to be able to listen to one or more professionals and to listen to ourselves, too. After all, we’re not subjects who must do as we are ordered. We are sovereign citizens who get to have input and make choices ourselves. Remember the procedure when we go in for a checkup. Someone takes our vitals. We wait. The physician or NP or whoever comes in, looks us over, talks about concerns, then leaves. What happens after the doctor leaves the examination room is that they often go to consult the PDR, the Physician’s Desk Reference, now online, of course. They may go look up recommendations for medication and for treatment because they don’t trust themselves to keep all that knowledge at their fingertips all day long. Patients can consult the PDR and other sources, too. I like to look up drug interactions and side effects. I think sometimes physicians don’t really worry about those things because they are mostly fairly rare. Fairly rare isn’t good enough for me. I want to know what the side effects might be so I can recognize them if I begin to notice anything.
We must be diplomatic. Bureaucracies, medical or otherwise, don’t like to have their feathers ruffled. They don’t like to be threatened, either, especially when they deserve it. They don’t like to be shouted at, either. Nor do we. So make the effort to phrase things in a cordial way. A good policy is to ask good questions and let them answer. They are there to provide skilled care, and you are there to consume it. They should be able to explain things so we can understand them. If they get defensive too fast, it might not be a good sign. If you’ve done some research, then the questions will be better and the answers more to the point. Smiles get a better response than unjustified sarcasm or demands.
With all this being said, there are still remarkable opportunities for healthcare we could not imagine just a few decades ago. Keep your eyes wide open and study the system as it changes. We can be depended upon to have our own best interests in mind when we visit and listen to medical professionals. Wish us luck.
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Dr. Bruce Smith (Inkwell, Hearth and Plow) is a retired professor of history and a lifelong observer of politics and world events. He holds degrees from Indiana University and the University of Notre Dame. In addition to writing, he works as a caretaker and handyman. His non-fiction book The War Comes to Plum Street, about daily life in the 1930s and during World War II, may be ordered from Indiana University Press.