JUNE 4, 2021
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AUGUSTAMEDICALEXAMiNER
The blog spot From the Bookshelf — posted by Suneel Dhand, MD, on May 25, 2021 (edited for space)
3 REASONS WHY PATIENTS ARE UNHAPPY When I’m working in the hospital, I always find it interesting talking to patients about their medical history and experiences with outpatient physicians. The state of our primary care system is reflected in the comments I receive from patients. Despite the best efforts of an amazingly dedicated number of doctors, it’s often an impossible job in today’s health care system. Interestingly, I rarely hear patients complain to me about costs or that a certain test or procedure may not be covered by insurance. It’s always about their experiences with the health care system on a human level. Here are the top 3 reasons I hear for why people are unhappy:
It’s rarely about cost
1. My appointments are either impossible to get or too rushed. Faced with enormous demand on outpatient clinics and ever-increasing bureaucratic requirements, doctors everywhere are finding it extremely difficult to spend adequate time with patients. Sadly, this becomes an even bigger problem when dealing with aging and more medically complex patients. There’s no easy answer if there’s simply not enough supply of doctors or incentives for graduates to go into said specialty. But the doctors that are left to see patients have to find a way to make the most out of the time available. We always need to utilize good communication skills such as ensuring adequate eye contact (assuming in-person visits, which patients overwhelmingly prefer post-COVID) and empathetic active listening techniques. No staring at the screen when we should be looking at our patient! 2. I keep seeing a different clinician. This is one of the saddest things I keep hearing, especially from patients with a long list of medical problems. They are “officially” assigned to one doctor, but each visit will see a different doctor, nurse practitioner, or physician assistant. They desperately need one go-to clinician to be the captain of the ship. But resources are scarce, and this isn’t possible. Hence what I call a merry-go-round of new doctor encounters with the same patient. This is very easy for me to spot on the electronic medical record and is suboptimal to good clinical care. 3. My doctor doesn’t seem to care, and the office rarely returns my calls. Whenever I hear this, it always hits me hard. To be clear, it’s a very small number of people who say something like this—but it’s one of the worst things any patient can think. Of course, I don’t know the backgrounds, but I do see people who seem like very reasonable folks give this feedback. If that truly is what any patient thinks, I only have one piece of advice for them: Find another doctor ASAP! In fact, I often go further than that, and even I hand them contact information for other doctors in the area. Your health is simply too important for you to feel like your doctor is not on your side. I believe that all the problems we face within our health care system are all right there beneath the surface. They are a simmering volcano waiting to erupt as soon as we come out of the pandemic. There is a shortage of physicians, a lack of focus on primary care and prevention, mind-numbing bureaucracy, and the pain of dealing with 3rd parties. The nation’s overall health continues to decline while the costs of the system continue to escalate. It doesn’t take an Einstein to work out that those two things are incompatible, and the system will reach a complete breaking point in the not too distant future. + Suneel Dhand is an internal medicine physician
There is a lot of middleclass suburbia in the Augusta area. But there are also entire neighborhoods in the Garden City where the houses look like sharecropper shacks from some tiny poverty-stricken town in the 1930s. In other words, in some ways we aren’t too far removed from Brick City, the nickname for Newark, New Jersey, a city we might automatically (and perhaps unfairly) associate with rust belt inner city poverty and crime. If you grew up there and care about yourself and your family and your future, you want to better yourself. In short, you want to get out. That’s what’s kind of amazing about the journey of Dr. Sampson Davis, the author of Living and Dying in Brick City. It’s not much of a journey: he was born and raised in Newark, then grew up to live and work there. On the other hand, it’s an incredible journey: he was born and raised in Newark, was arrested for armed robbery as a teenager there; saw his sister become a drug
addict there and subsequently die of AIDS there; saw his alcoholic older brother become paralyzed as the result of injuries in a bar fight there; and then after all that, he grew up to live and work in that very city. And not just at any job, either. As you’ve probably already noted, he’s a physician. This book is his chronicle of working in the ER at Newark’s Beth Israel Medical Center, often treating patients he grew up with. Variously described as “riveting,” “informative,” “heartfelt,” “dramatic,” and “powerful,” Living and
Dying in Brick City looks at medicine through both micro and macro lenses. He tells tales of treating gunshot wounds in patients he has known since childhood, and also takes a big picture approach and makes some pointed observations about the overall state of healthcare delivery in the United States. Along the way, topics like gang and gun violence, drug dependence, domestic abuse, sexually transmitted diseases, mental illness, unwanted pregnancy and obesity inescapably arise. Unfortunately, they are problems to which no city, including Augusta, is immune. As one New Jersey newspaper noted in its review of this important book, it should be required reading “for the kids in suburbia who have no idea what life is like in the inner cities, and for the kids in the inner cities to know that there is a way out.” + Living and Dying in Brick City, by Sampson Davis, M.D., 256 pages, published in February 2014 by Siegel & Grau
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