Friday, November 6, 2009

Want to reform human healthcare? Start by acting more like veterinarians!

Transcript of personal comment from this episode of The Web-DVM:

We have a little change in format tonight, as we are forgoing news stories in lieu of a more than typical substantial personal comment tonight. My comment deals with a subject that is in the forefront of the minds of most Americans right now, the subject of human health care. While I agree that our health care system is badly in need of reform, that health insurance companies are a big part of the problem, where that aspect of reform should go is not within the scope if this program.

The reform I am talking about, starts at the level of the care givers and health institutions themselves, to hold themselves accountable to a higher standard, in short, to start acting more like the veterinary industry does. If you bear with me for the few several minutes, I briefly want to recount two recent personal experiences I had in the human health care system that are abominable examples of what is wrong with our health care system, then explain to you how we veterinarians do it differently, and frankly, emphatically better.

On week 16 of my wife's pregnancy with our beloved Austin, she was out to dinner with her brothers when she suddenly experience a gush of clear fluid. Terrified that she may have expelled life sustaining amniotic fluid, she proceeded straight to the emergency room having called me to meet her there en route.

Upon arrival, we began our experience by waiting more than 90 minutes from admission to actually having her in a bed and ready to be examined. Once there, we were greeted by nurses, but there was still another thirty minutes before a physician came in to see her. Only the caregiver that came in was not a physician at all, but a physician assistant, known by the abbreviated term, PA. After she performed her examination and told us she suspected a threatened miscarriage, I asked her when the doctor would be in, to which she replied, there would be no doctor, that she was the assigned care giver in the emergency room that evening. Apparently, potentially losing your unborn child and having excellent health insurance does not qualify for actually getting an MD in this hospital.

The PA next came in with a device called a Doppler to check for the baby's heartbeat. Having seen my wife's regular top notch OBGYN take some time to locate the heartbeat previously with a Doppler, and having had a lot of personal experience with the use Doppler in animals, I knew that there was an art to successfully using Doppler, the mastering of which comes with experience.

I watched as this PA was clearly not confident with the device, while she failed to find my baby's heartbeat. She then told us that since Doppler was not infallible (at least in her hands), the definitive state of the baby could not be determined, but that the signs did not look good. Her recommendation was that was we go home and call our OBGYN first thing Monday morning to have an ultrasound scheduled. Dumbfounded at this point since it was Friday, I asked her why we could not get an ultrasound right then and there, and her answer was that the urgency of the situation would not allow her the authority to order one!

Having quickly gone from dumbfounded to appalled, I asked her to meet me outside the room in the hallway, where I told her that I will not allow her to enact such cruelty on my wife and I, to make us go through the emotional turmoil of an entire weekend of not knowing whether or not our baby lived. I told her in no uncertain terms that if denying us an ultrasound was her final position, that Monday morning I would not only be calling the OBGYN, but also submitting a grievance with the Florida state medical board, as well seek out the most aggressive shark of a lawyer I could find and sue them.

As luck would have it, my discussion with the PA revealed that an ultrasound was not out of the question after all, and my wife was promptly taken into ultrasound, where we saw our little guy happily swimming around in Mommy's uterus. I was so elated, I hugged the ultrasonographer, not only because of the news her scan brought us, but also because her diagnostic capability was the only bit of professionalism and quality care we had received the entire evening.

In another recent health care experience, I was referred to a specialist by my primary doctor. To my dismay, it would be 3 weeks before I could be seen by this specialist, and the only other alternative for this specialty was all the way in Orlando. Also to my dismay this specialist, as it turned out, only actually worked 3 1/2 days a week.

After I finally had my appointment with this doctor, he had ordered a battery of blood tests, telling me that they would be in in one week, and that I should call back then for results. I called as he said one week later and a nurse confirmed that the blood work was in. This is when the fun really began.

She promptly was about to refer me to the receptionist so I could make an appointment with the doctor to review the blood work, when I asked her why he could not go over results over the telephone as I do for my clients. She proclaimed that the doctor as a strict policy does not review labs results over the telephone, that it must be done in person with an office visit. At this point very unhappy with the way I was being treated, I was still was willing to go along with this nonsense, until I was informed that it would be another 2 weeks to get an appointment to review my labs!

Right then, I was done with this doctor. After making me wait 3 weeks for an appointment and one week for the test results, just so that he could bill my insurance company another office visit, he was making me wait another 2 weeks to get my results. No way!

I told the nurse that I was effectively done with this doctor, that his policies and lack of accommodation was disgusting, and demanded that she fax me my lab results. I interpret lab data every day for dogs and cats, much of which are the same parameters as for people, so I certainly was capable of interpreting my own. And if not, I would drive to another state for help, rather than take this abuse any further.

This last part is the icing on the cake. When I demanded to get my lab work faxed to me, the nurse informed me that she could not, for the administrative paper pusher that normally was in charge of something like that, was on vacation and would not be back for another week. I said to the nurse, "So you are telling me that there is only one person in your office that is capable of sending a fax?" Her answer to me was that it was not a matter of being capable, but that it was policy that only this one person was in charge or processing paperwork. Finally, I said, "Go to your manager, doctor, or whoever your superior is today, and tell her that refusing to release my labs is both unethical and illegal in the state of Florida, and that she could either fax them to me immediately, or fax them at a later time when the Florida state medical board ordered them to after I filed my grievance. I had my results in hand 15 minutes later.

Being a health provider for dogs and cats, all I can say to the medical profession is four words, "ARE YOU KIDDING ME?" I would be put out of business and run out of town if I or my hospital behaved like this. Let me tell you how we do it in veterinary medicine so that you can see what real health care is.

No matter how booked up we are, we do not turn away a sick patient, find a way to fit them in, even if it means working through our lunch break and/or staying late, sometimes very late. Routine blood work is back within 10 minutes, most other blood work back within one business day, even tissue biopsies are back in 2 business days. When the results come in, I call the owner free of charge and review them, as well as answer any and all questions, no matter how long it takes.

When owners call with questions about a particular treatment course, refills, or just general questions, I communicate with them through a technician if possible to save time, but come to the telephone regularly myself if the questions are very involved, or if the client feels more comfortable talking directly to me.

When we have to refer a patient to a specialist, there is NEVER anything even approaching 3 week wait, with our nearby critical care and specialty referral center happy to receive patients right away, within minutes, or at most within an hour or two at most, even under non critical circumstances.

The bottom line is that in veterinary medicine, we think of the needs and well being of the patient first and foremost, rather operate with abject apathy and arrogance under the guise of policy, red tape, and feeling that we are justified in charging for every single word we speak.

All this said, this is not an indictment of all medical doctors and health care institutions. For example, the rest of my wife's pregnancy with Austin unfortunately was not smooth, and it was ultimately the tireless dedication of our wonderful OBGYN group that delivered him safely to us, not a hair on his little head harmed. In a nut shell, this OB group operates more like us.

Unfortunately, health care institutions like the ones that saved my son's life, are becoming increasingly the minority, with the nonsense that I previously relayed to you, more the norm. Congress will hash out what they will, and people will debate and shout until they are blue in the face on how health care reform should proceed. Regardless of whatever the result of that debate is, health care providers should think long and hard about reforming themselves first and foremost and becoming a little more like us.

Dr. Roger Welton is the President and chief veterinarian at Maybeck Animal Hospital in West Melbourne Florida, as well as CEO of the veterinary advice and health management website


Tom Degan's Daily Rant said...

"This bill is the greatest threat to freedom that I have seen in the nineteen years I have been here in Washington"

John Boehner
November 5, 2009

Oh, dear! Where was this knucklehead on September 11, 2001? Or when the Patriot Act was passed for that matter. Where was this fool in 2000 when the Supreme Court put a stop to the vote counting in the state of Florida and installed the Bush Mob in the White House? The greatest threat to freedom in nineteen years? Have another sip, Mr. Faux Tan Man.

Tom Degan
Goshen, NY

Roger L. Welton, DVM said...
This comment has been removed by the author.
pw1974 said...

I am so glad that you focused on the industry itself and not all the back and forth on health insurance reform going on in politics. Because the majority of us do have insurance, some of us EXCELLENT insurance, and STILL we cannot get treated with an ounce of decency by these arrogant bastards. The doc's stories are just the tip of the iceberg - I have so many bad stories between myself and my family, I could write for hours about it, and still not get to half of it.

I love my veterinarian and his staff, and only wish that one day human health institutions, from the doctors to the receptionists, to the nurses, could treat their patients with just a fraction of the dedication, compassion, courtesy, and quality that my vet's hospital treats theirs.

kurt70 said...

Hey Doc, I must say that the stories that you told are definately telling, but really are just the tip of the iceberg. I am sure that every person out there has stories just like that, and probably more numerous and worse.

I say time and again that I wish my vet could also take care of my and my family's healthcare, because the care, the attention, the bedside manner, the courtesy, just kicks the crap out of any medical doctor I have EVER seen!

Anonymous MD said...

Dr. Welton,

I find it interesting that your bad experiences were with institutions where essentially, ther eis no cjoice. There is an emergency, you go to the nearest place. You need to see a very highly specialized physician where there are not many around, you go to the one that is there.

I work in a the more common specialty of internal medicine, and like many in my specialty, incorporate alot of general and family medicine in my practice. Typicall, there are a few of us around in any given municipality, to like you, if we behaved like hethens, we too would be out of business and run out of town.

You mentioned how please you were with your OBGYN, another more common specialty, where, were you treated poorly, you can likely find another option close by.

Ont he flip side, when you are courteous and do a good job, you are rewarded with owrd of mouth referrals.

Choices essentially make a profession better, and unfortunately when it comes to the ER and highly specialized phsycians, choice is taken out of teh equation, enabling them to act with impunity with few consequences.

Veterinary medicine for the most part seems to offer choices to pet owners, with at least 3 veterinary clinics in my small city to choose from. This is why you are held to a higher standard than alot of human medicine. You are mandated to to continue to stay in business and thrive. But, to state that this is increasingly minority is hman medicine, is really unafir. Most of human medicine is by choice and, as such, we are bound by the same tennants as you. This includes internists like me, dermatologists, ENT, OBGYN, and any other field that is non-emergency, completely elective, and generally offers numerous choices.

Great commentary, though, for you touched on a side a human medicine that is less than becoming, and unfortunately taints the profession for those of us who strive to do it right.

pw1974 said...

Okay, Anonymous MD, you make a very good point about increasing consumer choices making an industry better. I did not want to go there, but isn't that what the democrats are trying to do with the insuance exchange and the public option in this health care reform bill? To create choices so that the insurance industry cannot act however despicably they want?

In my state, there are 3 health insurance company options because that is all my state will allow to compete within it! It is the states that bloock other competition, and as a result, we are left with VERY little CHOICE!

I say, pass the bill , and give us choice!

Roger L. Welton, DVM said...

Anonymous MD,

Thank you for your comments, you make a good point to be sure. However, at least for myself, my associate, and my employees, our main motivation is not consumer choice primarily, our main motivation is that we like treating our patients and the people that love them well.

We feel good when people leave our office with a smile, knowing that because of our actions, our behavior, and our care, they had a good experience. In a health care industry, vet or human, primary motivation should not be consumer choice, and they should not necessarily by default bahve like scoundrels just because their branch offers little choice!

We have an affiliated emergency clinic that is the closest one to my office, with the other 20 miles from my office. We refer to them exclusively because with emergencies, time is often of the essence, and they are only 10 minutes away.

Yet, you never see them remotely act like the human ER, treat you with apathy, and hold you hostage for hour on end with little answers. They are also a referral center with a borad certified neurologist and surgical specialist, the sureon being one of only 2 in the county, and the neurologist being the only one within 60 miles. Yet, never do they act like the specialist that I had to see.

We do no forsake good care. good bedside manner, compassion, and a sense of decency, just because people lack choice in the matter. To act with only your bottom line as motivation, still gives our profession much greater integrity than yours.

Anonymous MD said...

Doc, if you really firmly believe that your bottom line does not influence that wonderful courtesy and service you provide, I believe you that you honestly think that - however, you are a bit delusional in that thought.

Pw, I do agree that consumer choice is the key for any industry to keep itself honest, which is why I am full in favor of an inurance exchange across state lines. Why it is not that way already is beyond me.

However, I am not in favor of the public option. Talk about lack of accoutability, the government takes the cake! Government entities do not have to balance their books, can run deficits, and act in a manner that would make the rest of us bankrupt. As such, the public option will NOT have to pay for itself through its members premiums as the deomcrats claim it will. And since it will not have to be paid for by premiums alone, taxes will go up to mend the debacle it is going to be. Also, because it will not have to be fiscally responsible, it will will offer rates that no private insurers can compete with, and little by little drum them out of the game. And one day in the not so far off future, we will find the goverment, that institution that is worse than any other on the planet for not having accountability, our only stinking option to insure ourselves.

My vote, have the insurance exchange, let multiple companies compete across state lines like in the car insurance industry, stop right there, and let that lie for a few years. If that alone does not bring down premiums bringing more people into the system, as well as create a mandate where the insurance companies simply have to improve their services or not compete, then consider further reform.

I suspect that competition alone would fix a heck of a lot - I'd be willing to wager that this would go a long way toward fixing what is wrong with our health insurance industry.

pw1974 said...

WHat but of "option" so people not get??? It is not the public mandate, but the public OPTION! All due respect, Dr. Anonymous, but your argument stinks. We already have public option flood insurance option, and that has not put any private insurers out of business. We have public higher education options with the subsidized state universites offering a quality, afforbale, college education, yet there are still plenty of takers for the private universities.

France and Switzerland both have hybrid public and private health insurance systems, and the rpivate still stay very much in business, which their health care systems are both within the top 5 in the world.

This whole slippery slope to government health care take over is the weakest argument out there, yet for some reason it gets the most play. Why does such a weak argument get so much play? Because that is all the opposition has - instilling fear and paranoia over some imagined socialist health care system. The same tactics were used to attempt to block Medicare 40 years ago - still waiting for that slippery slope!