Limited Access to Healthcare?
By Diane M. Goodman, APRN, BC, MSN-C, CCRN, CNRN
At a recent research conference, I listened to two colleagues battling back and forth about access to healthcare, and what the audience viewed as a "two-tiered" system; those who have insurance coverage versus those who do not. Government statistics from the U.S. Census Bureau (2009) place the uninsured population in the U.S. at approximately 16.7%, or 50.7 million and growing.
While I listened to my colleagues, and fully understood their point of view, I firmly believe there are many tiers within our current system of healthcare, and not all of them have to do with reimbursement, HMOs, PPOs, Medicaid, Medicare, etc. I believe the problem to be more basic than our payment system. It has to do with being able to effectively communicate and collaborate with the physicians/providers who are managing patient care.
To demonstrate my point, when was the last time you tried discussing an impromptu condition with a physician, nurse or allied health provider? Were you able to get past the computer-generated office recording to speak with an actual person? If so, was the person able to answer medical questions, or were they only able to tell you the nurse/physician was "busy with other patients," "out of the office for several days" or would not be able to return your call until sometime "later in the day"? As you waited anxiously by the phone, you may have realized the return phone call would occur only if the secretary/ receptionist communicated your concerns with the same degree of urgency you were experiencing. Who hasn't had this experience when seeking medical advice regarding the seriousness of an acute symptom or change in condition?
After several years of dealing with a chronic illness, I have found that "limited access to healthcare" has become the process by which we try to interact with care providers in our profession. Physicians prefer to avoid giving medical advice over the phone, perhaps a result of protecting themselves in a highly litigious society, or working within states sans tort reform. For the patient (consumer), however, it becomes a catch-22 when no office appointments are readily available, or the patient is thus advised by office personnel to "go to the emergency room" for assistance.
Once in the emergency room, however, the first question from emergency room staff is typically "have you discussed this problem with your primary care physician"? The patient is left to wonder, isn't this all a little confusing? Emergency room physicians can be somewhat disinterested in managing chronicity, as ERs become busier and busier with trauma and acute illness. They much prefer you to discuss new symptomatology with physicians who know and understand your "norms," as opposed to determining what is acute, what is chronic and what might be a mixture of both.
The subtleties of vague neurological symptoms may present a particularly baffling picture. Several weeks ago, I experienced transient episodes of horizontal diplopia (double vision), scary enough for me to seek advice from specialists, but not persistent enough to warrant a question and answer session (and relatively high insurance deductible) from local emergency room physicians.
The most frightening aspect of this experience was my inability to discuss new symptoms with my providers. Several messages had been left with the secretary/receptionist at the specialist's office, including those left on a computer-generated voicemail, but unfortunately, we did not receive a call-back. This, to me, represents what could be called the most basic of "limited access" to healthcare. At the end of the day, we were left with a dismaying dilemma; do nothing and hope for the best, or head to the ER for a (perhaps) unnecessary and expensive waste of time and resources.
As a nurse practitioner, I have learned to manage many of my healthcare needs. As the double vision adjusted, I read and researched what I could find on horizontal acute diplopia. Nothing seemed to indicate a life-threatening emergency, so we rode it out. By the time we did receive a call back (the following Monday), we found the information to be nearly identical to what I had discovered during my research. The diplopia could be serious, but it was more likely an annoying symptom of my neurological condition, or a medication side effect. I was lucky; I had chosen the correct path.
What about consumers without the luxury of healthcare knowledge or the ability to independently research their symptoms? Have we arrived at an abyss in healthcare, where the "haves" are forced to wade through convoluted processes in order to obtain basic information and care? Is this where we want to be? For this acute symptom, I was lucky. The next time I require assistance, I hope to receive timely reassurance as well.