Part IV
A Patient gets discharged from an Affiliated OHSU Hospital Forty-Eight Hours Post-Admission to the Observation Unit Without Ever Being Seen by a Physician:
We are Witnessing a New Trend in Medical Training!
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Before I engage in the complex subject of my concern, I would like to acquaint you with a few lines of poetry that seem to be entirely apropos to the present status of our nation and what we are going through:
Pity the nation whose people are sheep,
Pity the nation whose shepherds mislead them
Pity the nation whose leaders are liars, whose sages are silenced, and whose bigots haunt the airwaves.
Pity the nation that raises not its voice,
except to praise conquerors and acclaim the bully as a hero,
and aims to rule the world with force and by torture.
Pity the nation that knows no other language but its own,
and no other culture but its own.
Pity the nation whose breath is money,
and sleeps the sleep of the too well fed.
Pity the nation — oh, pity the people who allow their rights to erode,
and their freedoms to be washed away.
My country, tears of thee, sweet land of liberty.
I can identify so much with the thoughts and wording of Ferlinghetti’s poetry that it makes me think I was the actual poet. In my previous notes, I have alluded to the core meaning of the idea behind these writings. I see vividly the unbelievable decline in our nation’s social fibers. The question that keeps popping up in my mind is how long can we remain in a progressive society with our present behavior? I used the wording of “Nation of Sheep” to describe our condition. Many authors employed this sentence in various modalities to represent us in what they wanted the people to know.
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As a prelude to part IV, ” The Demise of American Medicine,” I want to review a few points from the previous sections and update them to the most recent ones if they are available.
Healthcare spending as a share of the GDP is increasing as the years go by. Our NHE (nationahealth expenditure) increased from 4.1% to 4.5% in 2022, meaning an average spending o$13,493/capita or 21% of NHE. Medicare increased 5.9% to $9443.00, and Medicaid grew 9.6% to $805.73.
Compared to other leading nations, the U.S. has the highest share of healthcare spending and consumes the highest share of GDP. Looking at the different elements under the umbrella of healthcare, the United States occupies the bottom line, and the statistics did not change by any significance measure of those enumerated in my previous articles. The 2020 data places American life expectancy at 77, Austria at 83.3, and Japan at 84.7.
Avoidable deaths per 100,000 population is higher in the U.S.: 336 versus 144, 147, 130, and 194 in Austria, Korea, Switzerland, and the United Kingdom, respectively. The average for OECD nations (Organization for Economic Co-Operation and Development) in 2020 was 225.
The United States ranks very high among the OECD countries in terms of mother and infant mortality. The numbers are identical to those in the previous writing. Physicians consult (patient physician visits) in all settings is one of the lowest among the OECD, 4.0, while Germany is 7.8, Japan 12.6, and Korea 12.7.
In January 2024, the number of physicians in the U.S. is reported to be 1,100,101. California has the highest number (119,087), followed by New York (101,861). The ratio of physician/patient in most areas runs between 300-400. The increased number does not change substantially the ratio of doctors/population.
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A few days ago, BBC reported that three-quarters of South Korean junior doctors went on strike. The government threatened to remove their licenses and sentence them to jail time. The quarrel between the doctors and the administration is related to the government’s decision to increase the number of physicians without appropriate safeguards for the existing medical community.
The news was exciting and provocative. A group of physicians went on strike to preserve what they perceived as unfair to their professional well-being. Since I am not fully aware of the nature of the grievance, I shall not discuss that part. However, I look at their action and see that they stood by their belief. That is what I like to see: the people fighting for their perceived legitimate rights, something that most American physicians cannot understand; they take whatever is thrown their way without any response.
A society can only claim to enjoy a high standard of living if it ensures that all its members have the right to express themselves and enjoy the standard of life they deserve. Almost for the past seventy years that I have been a part of the system, I have found that most American physicians have developed an apathetic view toward life and their profession. Remaining in a euphoric state, most of them create an aura of pseudo-happiness and either don’t care or become unable to see the future of their field and the responsibilities that go with it.
Long before it happened, it was evident that the system was undergoing significant changes. Not only most physicians but none of their organizations could see what was awaiting them. To most outsiders, these events were as clear as daylight. I vividly remember discussing with a fellow surgeon in the doctors’ lounge several decades back at the Memorial City Medical Center in Houston, TX, Dr. S. He was an accomplished and well-trained surgeon and a man with a good heart. He adopted several children whom he loved like his own. At the time, he was complaining about some changes made by the hospital administration and that they were not friendly to the doctors.
I expressed my opinion during our discussion, saying, “We need an organization to preserve our rights. You guys must help.”
He said, “You go ahead and start.”
“If I Start, will you join me?”
“No.”
His attitude was an approach most American physicians took. The medical organizations at the city, state, and national levels were not any better. AMA (American Medical Association) failed to understand what was happening. Why did it not fight the oncoming events? Why should individuals with minor education be entrusted with the management of medical care of the citizens? Why did the numerous local, state, and national organizations not explain the situation to the American public? Why do they remain dumb, mute, and blind to what has occurred in our healthcare? Now that all is in a disastrous condition, they say, “We should adapt to the new condition, accepting the poor medical care and the greed of people running the healthcare system.
In Harris County (Houston, Texas), the retired physicians have a wonderful organization, RPO (Retired Physician Organization), which started in the late 1990s. I talked with a few of its presidents about the mobilization of such great power in educating patients about their rights and guiding them to ask for medical care that is appropriate for them. My efforts failed to get any attention. Keeping the status quo was more comfortable for most individuals than starting a fight!
As I explained in my previous writings, the big businesses, mainly the hospital chains, wanted to get hold of a large share of money allocated for the nation’s healthcare. To achieve this goal, as I explained before, they initiated a chain of events that included help in eroding the most solid chain of patient-physician ties, marginalizing doctors’ functions, establishing systems using minimally trained individuals, replacing fully educated and trained physicians with those individuals, and more.
Names of doctors and physicians were replaced by “providers.” The word can mean anything, from the orderly on the hospital floor to nurses, nurse practitioners, physician assistants, doctors, etc.
One of the goals of the healthcare system was to minimize respect for physicians in hospitals and clinics, and they succeeded. The doctors cannot interfere with scheduling and must visit a predetermined number in each session. Most hospitals and clinics have introduced a “Patients Portal” system so registered patients can reach their physicians. However, in practice, most responses are from the staff members, nurses, P.A.s, etc. I can attest to this fact based on the responses from my physicians using the system. The reactions did not, in some cases, correspond to the question asked.
Reaching a physician by phone or through their offices, is almost an impossibility. If you call with a new complaint, your physician’s office will direct you to an E.R. visit. On most occasions, physicians have no control over the management of the office. In most cases, visiting an E.R. is a challenging task. It is enormously cumbersome and expensive. If you insist on obtaining a new appointment with your doctor, it may be several months away.
The unnecessary E.R. visits, greatly encouraged by the so-called doctors’ offices, overload the system; patients must wait hours to be seen. At the same time, these visits drive up medical expenses to an unacceptable range, benefiting big corporations and ultimately yielding poorer medical practices.
Most E.R. physicians are well-qualified and perform excellently. For legal purposes, in the interest of time, and to try to reach a diagnosis, these doctors perform a battery of tests on patients, some unnecessary if their doctors saw them. These procedures are costly and quickly reach thousands of dollars, which is an excellent income for the institution. What happens to the patients after the E.R. visits is a matter of great concern, and I shall address them specifically a little later; however, I explained some of those in my previous notes.
Taking care of patients by the “providers” is the primary source of difficulties. In my previous notes under this heading, I pointed out my involvement at the Baylor College of Medicine when the program was evaluated for its use. We were told that, positively, the physician assistants would see patients under the strict supervision of a licensed physician. If those words were valid, the situation would have changed 100%.
This group of so-called providers would have been able to contribute to medical care only if the system observed the spirit of this association with a fully trained medical doctor. They could assist the practice in running smoothly and guide physicians in using their time more efficiently. What I have enumerated is only possible under the strictest rules. In practice, what we observe is far from the original expressed condition.
It is hard to predict what kind of services our medical care institutions give American patients, specifically to the nation’s senior citizens. The outcome of these groups’ work can be summarized as one phrase, ” Don’t know how,” which is far from an acceptable measure.
The medical practice in today’s U.S. has nothing in common with actual medical science. It is geared only to satisfy the greed of those running the health systems. All statistical reviews show that Americans get the poorest medical services among OECD countries. The target of this unacceptable type of treatment is older people, those with multiple difficulties. They will not get admitted on time, will not receive proper care, and will be discharged prematurely, in keeping patients’ hospital days law and achieving their goal. The lack of responsibilities of the hospitals is at the core of the problems.
It is challenging to explain the patients’ frustration and dismay at U.S. healthcare. Aside from medical care per se, the price of prescription drugs is skyrocketing. They are increasing exponentially on the time element. To give you an idea of the copay on an eye drop for glaucoma, Combigan (primo/timolol) has increased from $67.00 to $90.00 and the most recent one to $141.00 in a few months. It was the same insurance company and the same plan. It is not only the Combigan; imagine patients who are dealing with multiple problems and need to take multiple medications.
I mentioned that visiting and obtaining a timely physician appointment has becaome almost impossible. Let me make it clear what this statement means. As an example, an elderly lady suffering from multiple medical problems, including a complex immunological disorder, was also suffering from an unusual dermatological condition manifested by markedly thin, fragile skin with severe itching and extremely painful to touch. I got involved in this instance and called my dermatologist’s office in the Beaverton area and explained the situation. I asked for an appointment for her with Dr. H. Here is how the conversation took place:
She said: “Dr. H’s schedule is full, and he does not accept new patients.”
__ “Can you give her an appointment with any other dermatologist?”
__ “I can make her an appointment to see a P.A. in March. No other appointments are available.”
I placed that call in mid-December. When I insisted that the patient presented a complicated condition and needed to be seen by a qualified dermatologist, she stated, “That is the best that I can do.”
The last blow came our way in the latter part of February 2024. My wife developed an acute episode of urinary tract infection, most likely due to a drug given to her by her cardiologist, Jardiance, for a better performance of her heart. Her present problem could have quickly been resolved with an office visit, a urine culture, and an antibiotic. We could not get an appointment with her physician and were told by the office to take her to an E.R. facility. She endured the difficulty of an ambulance ride and was taken to an OHSU hospital affiliate in Hillsboro, OR.
The E.R. physician, a young lady, was most cooperative and courteous. She was well knowledgeable in the field. The preliminary tests confirmed the diagnosis of urinary tract infection, and after, she was started on a broad-spectrum antibiotic. Based on her multiple medical difficulties, she suggested hospitalization, with which we were in total agreement.
We were told to go home, promising that she would call us. At about three AM, I received a call from her that my wife was admitted to the observation ward pending the availability of a bed on the floor. The following day, visiting my wife, we got a chance to meet a young lady who introduced herself as the “Nurse Practitioner in charge of her.” In a short conversation with this “provider,” it became evident that her knowledge of medicine was, as the saying goes, as much as the pig knows about Sundays. Her opinion changed from admitting her to keeping her in the observation unit to discharging her home. She ignored and did not answer my numerous questions, “Who is my wife’s doctor? I want to talk to them?”
Instead, she kept repeating that her infection would be taken care of with the antibiotics. At that time, the patient had developed an episode of atrial fibrillation with bouts of pacemaker-mediated contraction simulating ventricular tachycardia. It was then when I screamed at her that she better see what a cardiologist would suggest for her to do. She could not even distinguish between normal sinus rhythm and fibrillation on the cardiac monitoring device at the bedsideFinally, the floor nurse brought her a dose of her medication. I could not talk to a physician simply because she had no physician! Acting as a physician, the nurse practitioner refused our demand, asking for a cardiac consult. She said those could be done as outpatients and that her hospitalization is for the UTI treatment.
I could no longer tolerate her ignorance and told her, “Young lady, you should treat the patient as a whole and not only for a single disease entity. Didn’t they teach you anything in nursing school or during your studies for your present profession?”
Finally, after much discussion, she, the acting doctor, accepted our suggestion to remove the bladder catheter to see if the patient could void without it, and she decided to keep the patient in the hospital.
On the following day, we were greeted by another “Provider,” a PA (Physician Assistant). I soon realized that she possessed the same level of medical knowledge and the same type of reasoning, indicating her miniscule understanding of medicine and pride in power bestowed on her.
The patient’s heart rhythm was changing between fibrillation and abnormal pacing. Despite our requests, no cardiologist had seen her, and we could not find out why. Upon our continuous demand, our lady PA called a cardiologist for abnormal heart tracing. He confirmed what we already knew but did not speak to us, and we have yet to determine his contribution.
We decided to take my wife home. At least we could give her essential, acceptable medical care, and if the situation got worse, we would refrain from calling the doctor’s office and hear the immortal phrase, “If it is an emergency, hang up and Call 911.” Since the patient could not ride in the car, the hospital arranged for a medical transport system to transfer her to the house.
On my way home with our son, I pondered what we had witnessed for the preceding few days. Was this a teaching hospital managed by a medical school? What kind of teaching do the students get in such institutions? What type of training do the interns and residents receive there? What kind of physicians will they be after completing their so-called education?
A few good physicians are still practicing, but their numbers are dwindling and getting scarcer. A revolution in the medical field is necessary, and it should come from within, meaning the physicians themselves. Our medical organizations are the most incompetent, fostering no hope for betterment. They seem to subscribe to the idea that “We should not Rock the Boat.”
Guils of Guilan 