By Arjun Janah

I have learned, from experience with my aged parents and my younger sister-in-law, that elementary services, or even basic coverage, can be denied on the flimsiest of grounds.? My own experience with physicians and hospitals has been that I normally get at most 15 minutes with the first, and less than a day to recover after surgeries with the second, before being shown the door.? There is also no followup.

It is true that, given a reasonable plan (obtained either by means of collective bargaining if one is fortunate enough to belong to a large organization and so paying group-rates, or else by paying high individual-rate premiums if one is lucky enough to be affluent) expensive tests and high-tech procedures may be ordered, that often involve tens of thousands of dollars of charges.? But these seem to be driven more by considerations of profits than by true concern for the long-term well-being of the patients. Less profitable and less drastic procedures, that may be very simple, on the one hand, or may involve sizing up the whole individual and his/her history and circumstances, and utilizing lifestyle changes and long-term remedial services on the other, are simply not part of the health-care equation.? Though they might drastically reduce health care costs, while improving long-term outcomes, they yield less profit, and might even make much of the current health-care behemoth redundant.

A tremendous amount of effort goes into paperwork — leaving n urses, for example, relegating basic patient-care duties to nurses’ aides. Surgeons are usually unavailable after an operation, despite all that may go wrong during recovery. Internists often have little or no coordination with specialists, to whom the whole picture of the patient’s health is of little or no interest.

Doctors themselves run up huge debts in medical school, and are mercilessly driven as interns, where they often have shifts that run for days with little or no sleep, while yet being responsible for most of whatever little routine medical attention a ward patient receives. They then scramble to set up a practice, preferably in a lucrative surgical specialty, so as to pay off the debt, and then often endeavor to stay as far away from hospital wards and routine patient care as they can get.

Surgeons are willing to spend time with a patient prior to highly expensive (and often unnecessary, though profitable) surgeries, but usually have no time for them after-wards.? Other physicians? are forced to cram in as many patients as possible per day, either to meet their basic expenses and their chosen lifestyles, or else to satisfy HMO’s and hospitals for whom they work. Fifteen minutes has become the standard maximum per patient, including time for basic physican’s paperwork. Many spend far less time.? Basic examination tasks, once performed by physicians, are increasingly assigned to physicians’ assistants, nurses, medical assistants or others.? Those who buck this trend find them selves in trouble, either financially or with their overseers — often people who have no medical background.

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