Chapter 5: Health Care is a Business Model; Not a Caring Model

Medicine is big business that is driven by money and patient care is sometimes a secondary goal. It may seem that this would be an easy feature to spot, but it is not. Some physicians see 6-8 patients an hour, spending only five minutes per visit. The end result is poor quality health care.

Doctors and hospitals are not rewarded for providing good care. If health care systems want to survive they need to have a good business model. Seeing more patients, ordering higher priced services are two techniques used by health care systems to make money.

In order to make money, patient care is not optimal. When a doctor sees many patients he often has to take short cuts just to get through the day. Providing optimal care takes time. This does not fit in with making money.

Medications contribute to the business of American health care. Medicines are over-prescribed in part due to the marketing efforts of pharmaceutical companies. Drug companies make a lot of money.

Until the way health care is practiced is changed, there will not be an improvement in health care. When health care institutions are forced to use standards and are rewarded for using standard medical practices, we may see some changes. Health care providers need to be evaluated on outcomes, and quality of care. If they do well, they should be rewarded.

The way it stands right now, health care providers who can see the most patients are the ones who get rewarded. Under this current model, quality of care is thrown out the window.

Health care is paid for by business, without solid business practices, health would fold. Those who run health care want to make money. Often caring for you is secondary.

Business leaders have disturbing meetings. One business leader reported that they were disappointed that the H1N1 or swine flu outbreak in the spring of 2009 did not hit harder. This leader reported that their company spent a lot of money in advertising to let people know that they could come to their facility if they thought they were afflicted with the swine flu. When the outbreak was not as widespread as many health experts predicted, this leader said that she was upset.

While I was on vacation, my daughter woke up with a fever, sore throat and did not feel well. I did an exam on her I was highly suspicious that she had strep throat.

I was in North Carolina and it was a Sunday morning. I found an urgent care on the World Wide Web, which was located about 25 miles down the road. I gave my daughter a dose of ibuprofen and I packed her and my youngest son in the car.

I got to the urgent care center just as it opened. I was expecting a long wait, but I was lucky there were only about three patients ahead of us.

I wanted a strep culture for both my daughter and my son. The reason that I wanted a strep culture for my son was because he had a rash over the last few days. Strep throat can cause a sandpaper like rash over the body. Despite his rash he had no other indication of strep throat such as a fever or sore throat.

I was fairly sure that my son did not have strep throat, but I wanted the culture just to make sure given the fact that my daughter certainly had it.

After I filled out the forms for the urgent care, the urgent care waiting room was filling up. When they called my kids into the exam room, there were about 10 people waiting to be seen. The doctor had a busy day.

He came in and did a quick history and exam on my children. Instead of doing the strep culture, he decided to just treat them as though they had strep. Based on guidelines it was reasonable to do this with my daughter (she had enough there on history and physical exam to be pretty sure she had strep).

My son needed a strep culture. There was not enough there on exam or history to know for sure he had strep. But, it was easier to just prescribe the antibiotic than to perform the strep culture. While everything turned out just fine, he did get exposed to a course of antibiotics that he probably did not need.

This story drives home a couple points.

• This urgent care center was concerned about getting through this large number of patients and making money instead of providing quality care.
• Standards were not followed. Proper care was not provided.
• Little time was spent in teaching. We were not told what the diagnosis was or which antibiotic was given (a prescription was just called in).

While Americans are generally satisfied with their care, they should not be. Many Americans would describe the situation detailed above as great care, but it was not.

Doctors rarely do teaching. Patients often walk away from appointments with no idea what the doctor diagnosed them with or even the name of the medicine that they received. The doctor is in a hurry to get on to the next appointment.

The current capitalistic health care system focuses on profit instead of patient care. This does not mean that you cannot receive great health care in the current system. It does mean that you will have to do more than have a good doctor. You need to take responsibility for your health care. Health care responsibility includes understanding your health and disease states, organizing your health information and communicating with the system.