U.S. Health Care – And The Alaska Personal Experience
Contributed by Doug Ferguson
Because I have been dealing with the same condition, which is an abnormally high heart rate, I immediately jumped to a lead sentence in a recent article by a doctor in his article about health care in the U.S. that said, “I developed a serious cardiac arrhythmia, ventricular tachycardia, seven years ago, -- and my experience through this illustrates the good side as well as the bad side of medicine today.”
This thought rang a bell with me and I thought I should write about it also.
The doctor, John Abramson, teaches primary care and health care policy at the Harvard Medical School and is an author of two critical books on the health industry.
I won’t go into all the detail Abramson does to explain from a study, that compared to eleven other “wealthy” countries, so-called “privileged” Americans, have better health outcomes than other U.S. citizens, but still have worse outcomes than the average citizens of the eleven other countries while paying on average $12,914 per person per year on health care vs. $6,125 per person in those countries. This means “-- we are spending an excess $2.3 trillion a year and getting poorer results.”
He concludes “Which means that our health care system is broken and needs fixing.” He goes on to explain his view of the how and why of doing this.
I certainly won’t attempt to do anything like that here. However, I can relate some observations of the difference in the medical environment we were used to in Southern Minnesota before we moved to Alaska in 2017 to be closer to family and the environment we have experienced here and why it has contributed to our personal medical frustrations.
First some background of the medical environment in Minnesota. As many people know, the founding of the non-profit Mayo Clinic by the Mayo family in Rochester, MN in the late 1800’s established the “clinic” model for medical care in the United States which is now utilized around the world for patient care, medical research and medical progress in general.
At the actual patient care level that we are addressing here, the key to this model are several basic concepts and practices. One of the most important is that doctors are salaried “employees” of the clinic and therefore are not as motivated to use their personal patient practice to enhance their incomes. They are free to spend the time they believe is required with each patient for their best care.
Also key to the “clinic” concept is the idea of team communication where the specialists who see a patient during a clinic visit for a medical problem end up sharing their findings with one another to finally agree on a treatment plan. Also, each has all the detailed records for each patient at their disposal.
Another key feature of the “clinic” concept is that either an assigned “focal” point or, in the case of the clinic’s family practice business, a “family” doctor for each patient is necessary to negotiate these processes and make sure this communication occurs.
Each person’s medical problems are a complex interaction of many factors, some of which are well researched and known and others not so much. Therefore communications between the team attending the patient, the patient themselves and their families, is of primary importance to a successful treatment plan and outcome.
Now we come to our situation in Alaska. While our personal experience has led us to many expert medical personnel and specialists, each has been part of a separate organization and business unit. While some have more variety of expertise than others, none up here could be considered a “clinic” in the same scope we have been discussing.
Each of these organizations, while providing excellent medical services in the fields in which they operate and certainly wanting to co-operate with other groups, have restrictions and limits on what they share with other groups. Certainly the Federal Privacy rules have played a part here. Since my severe medical problems started early last fall, I must have initiated and signed several dozen information release forms!
In addition, each organization is very clear in letting you know what they consider is their area of expertise, not wanting to make judgements in another area. This makes the role of the family doctor very difficult in complex medical situations.
The unique problems we elderly have with the Medicare system add to all this complexity. I won’t go into our story of trying to find a family doctor near our home who would take Medicare when we first moved here!
There is no doubt in my mind that the “clinic” model of health care provides the best in our modern day. Here’s hoping that this can be part of Alaska in the future!