Who will take care of you?

I have written much and published little on this blog.  The fear of a Health Information Protection and Privacy Act violation looms large for me.  I have an interesting job that gives me a unique prospective not only on my chosen profession but on life and what it means to be an American.  I would love to be a syndicated columnist or consultant for a television news program but I have not written enough to be there - yet.  I know that as I have settled into this job of hospitalist, I have become more complacent and at times have been heard to say, "This is not something I have the power to fix." 

One of the problems I can't seem to crack, even in my small corner of the urban health care system, is access to care.  I realize the country is divided on who's responsibility it is to pay of health care.  I realize many do not share my conviction that we are all paying for the lack of health care for particularly children and the poor.  I realize those of us who do have health care receive it in a profit driven system that has made the least compassionate among us physicians multimillionaire.  BUT many of the common maladies of American kind could be treated and even eliminated with a modicum of care.

Take for example hypertension.  Yes, high blood pressure is silent for years before it causes the big problems such as stroke, renal insufficiency, and heart failure.  Again, in this country we pay for dialysis for anyone who has chronic renal failure.  We do not pay of blood pressure medication for those whose blood pressure is elevated.  Even in those who have good health insurance, little is done to help them understand the disease and factors they can control, dietary salt and weigh, along with the fact that medication is a life long necessity.

Our education system for doctors is doing little to help.  Most graduates do not want to pursue a primary care path.  Being a cardiologist, who goes to the cardiac cath or EP lab, thus getting the big bucks for treating heart disease, is the much preferred path to one of a family medicine doctor, who could influence the patient to prevent the heart disease in the first place.  Of course the business people are trying to change this by finding ways to get more money for primary care doctors or have "physician extenders" such as nurse practitioners or physician assistants provide entry level care. 

The bottom line will come in selling this to the patient.  If you are not paying much or nothing, such as those who get health care through an employer or the government, then you will probably accept it an complain.  Interestingly enough, I believe those people will get the best health care.  The rest are being sold a bill of goods.  You don't believe me?  Look up "hydrochlorthiazide."  This is an ancient blood pressure medication that made a comeback when it was found to be more effective, with fewer side effects, than newer, more expensive drugs.

A nurse practitioner, with your best interest at heart, will do more for your health than the best trained cardiologist.  Oh, and to my physician friends out there, when you are having trouble finding work, remember, we did this to ourselves.