Chapter 4: Health Care is Fragmented

Information does not always follow patients – there is no one place that knows all about your health. Fragmented health services are largely responsible for health care information not being in one place.

 Fragmentation is the use of multiple medical specialists or medical systems to care for one individual. One doctor caring for all of your medical needs is not the norm in today’s health care setting. Fragmentation of health care is one by-product of the health care monster in America. Fragmentation leads to duplicate medications and services, which is not only costly, but also potentially harmful or deadly.

An individual with diabetes, heart failure, prostate cancer and depression could be seeing six different doctors including an endocrinologist (doctor for diabetes), cardiologist (heart doctor), urologist (doctor of the urinary system), oncologist (cancer doctor), psychiatrist and a primary care doctor. With this many doctors treating the patient there is risk for duplication of services – such as two different doctors doing the same test or two different doctors prescribing similar or duplicate medications – and too few test being run (because one doctor assumes the other is running the test).

Poor communication between the specialists is commonplace and one specialist often has no idea what the other specialist is doing. The use of many health care providers often leads to use of many drugs. It is critical that each health care consumer helps monitor medicines to assure there are no duplications of medicines or drugs that interact with one another. It is also essential that each doctor knows which medications each of his patient’s are on.

Medical specialists, experts on any one-body system, are very valuable. With the plethora of research published every month, keeping up to date is not possible for any one doctor. There are over 4000 biomedical journals making it impossible for doctors to stay up to date on all areas of medicine. Many general physicians worry about the scope of their practice with all of this new data and inability to keep up with all of the new information.

While specialists are great resources, caution must be instituted when seeing specialists. Providing continuity in the health care system falls on the shoulder of each individual consumer of health care. Each individual needs to actively participate in his or her health care to help assure continuity. The first step is to communicate effectively within the health care system.

Primary care doctors often take care of their own patients in the hospital, but this takes away from their office practice. Consequently, many consult hospitalists. The hospitalist is a doctor specializing in care of the patient who is admitted to the hospital. These groups of physicians are experts in care of hospitalized patients and provide excellent care.

The hospital is a time when the body is in a broken down state and care needs to be maintained or dire consequences will ensue. While the hospitalists does a good job at caring for hospitalized patients they are typically not familiar with their patient’s medical history. When being care for by a hospitalist, conveying a complete and accurate medical history is critical – it may mean the difference between life and death. Doctor Appointments

Doctor appointments fall below the expectation of many patients. The average office visit is approximately 15 minutes (and many patients would argue the average visit is much less than this). These 15 minutes include the health care provider reviewing the chart, talking to the patient, examining the patient, charting, answering questions, filling out forms and giving out prescriptions. Time limits placed on office visits do not allow the physician to spend adequate time with the patient.

Many patients complain about long waits within the health care system. Long waits in the emergency room or doctor’s office is considered normal. Many physician offices require an initial visit so a complete history and physical exam can be preformed before being seen for urgent problems. Doctor offices often have waits of one to two months for this initial appointment – they are more time consuming. When an individual needs to see the health care provider for an acute illness, the doctor’s office will not see the patient until this initial visit is carried out.

Patients need to learn how to best utilize office visits. Time constrains limit the time health care providers have to discuss medical care with patients. Health care consumers need to maximize this short time with the doctor. This includes being organized and knowing how to communicate with the health care system.