Thursday, April 16, 2020

A Healthcare System Broken in Unforeseen Ways

We know about the most extreme examples. We know, in broad strokes, what COVID-19 is doing to our medical system and how our providers are facing extreme challenges. But within massive problems like the kind that make the news are the prosaic stories of everyday Americans. They reveal the routine challenges medical professionals and patients both are now facing. The coronavirus is revealing much about deficiencies in the system, not just financially or in, say, food supply. This pandemic has revealed severe shortfalls in doctor education on the matter of new medical and technological advances, causing disruptive gaps in coverage for everyone.

Specifically, the speciality to which I refer in this essay is that of psychiatrists and psychiatry. Both were already experiencing disturbing shortages prior to the pandemic, but now the whole field is stressed to the gills. And, to be perfectly honest, part of it is purely their fault, purely of their own doing. Many older doctors resisted learning about tele-health for years and as a result have proven to their patients a special kind of incompetence. The same sort of ineptitude is present in their staffs as well, who cannot adequately guide doctors to meet with those who need care, who might otherwise risk their lives if they make a journey into public.

But I also see tele-medicine done flawlessly correct. It’s possible to get it right. I’m right on the cusp of Generation X and the Millennials, and so is my psychologist. We’ve grown up with the technology. She understands the technology well and I’ve had no problems whatsoever connecting remotely with her. She sends out timely e-mails reminding me to log in properly and we get to work. You might say we’re a good patient/provider team. This is in great contrast to my previous psychiatrist, who was so much of a Luddite that he refused to use a computer at all. He literally wrote out every patient note by hand and vowed he would never change his ways.

Due to a set of circumstances I’d rather not discuss again, I had to find a new psychiatrist very much at the spur of the moment. This doctor seems like a competent man in his field, but his technological skills are, shall we say, lacking. He could have easily called me on the phone, but he insisted using tele-health instead, a skill he clearly does not understand. It is my understanding that his persistence is an insurance matter. He wants to get paid. Tele-health is covered by insurance while a good old fashioned phone call is not. But I’ve gotten conflicting information, too.

This is just one set of circumstances where we are behind the curve, not flattening it. I fear for infected people who may be reached too late, of course, but the problem goes much deeper. It angers me that some medical providers believed that their own education never needed to be continual. The mentally ill may not be dying, but they are suffering more than they did before we all went on lock-down. When psychiatric beds are being taken away from psych wards to treat coronavirus patience, very sick, emotionally unwell individual have one less option towards treatment available to him or her. Couple this with co-morbid factors like drug addiction and we see a perfect storm brewing in our midst.

But in the meantime, let’s take this as our opportunity to shore up the gaps. I’m sick and tired of seeing supposedly sensible people play kick the can. We needed all of this years ago. If it takes another month of quarantine to put in place the hard lessons we should have already taken to heart and memorized, so be it. It’s a maddening quality of humanity that people only do what is right when they have no other option but to act in everyone’s best interest. Informed patients deserve informed doctors.    

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