When you are admitted to a hospital, you will most likely be admitted by a Hospital Medicine physician. These physicians specialize in treating the complexities of hospitalized patients. The goal is to efficiently and effectively manage acute illnesses, reduce length of hospital stay, while maximizing patient experience. It is quite the challenge on a daily basis, but one that is very rewarding at the end of the day.
In modern medicine, it is absolutely fascinating how quickly we can reach a diagnosis, understand the physiology at play, launch a treatment plan, and get a unconscious or at times a person with no heart beat initially, walk out of the hospital in a matter of few days.
I have been doing this line of work for 10 straight years, holding various leadership positions, and one day realized that all the great work we did in the hospital can quickly become undone once the patient leaves the hospital.
Either the patient could not get a primary care follow up within 7 days of discharge, had too many specialist follow ups ultimately confusing the family and the patient, or cost of medications or lack of insurance was a barrier to follow up. Quite honestly, it really doesn't matter if they have insurance. The issue of access and cost is far greater than coverage. I also learned there was a lack of awareness of community resources from patients and physicians.
Picture this - you go to high school, college, medical school, then residency, then get employed by a large hospital system. So your understanding of health care becomes institutionalized and biased. The only community resources you know comes from who the health system partners with and THAT IS IT. You work too many hours to step outside the health system to fully understand the community you serve.
Having started a Direct Primary Care practice, forced me to get outside my comfort zone. I attended and joined multiple Chambers of Commerce, attended Rotary Clubs, shake hands with random people, drinking lots of damn coffee at coffee shops for one on one meets, and listen and learn from professionals who are doing incredible work in my community. These are small businesses that deliver quality personalized care. More importantly, you can feel their passion for what they do. A referral I made was not another number in their monthly quota. The referral was treated with special attention and an opportunity to build a relationship.
In addition to meeting amazing people in the community, as a Direct Primary Care physician who also works in the hospital, I started to understand how some of the education we did at discharge was overwhelming patients. For example, heart failure patients are aggressively educated to prevent readmission within 30 days to prevent loss of revenue for the hospital, so the checklist of items must be completed. In the process, someone with stable heart failure, discharges thinking the end is near for them. They would sign up with our practice overwhelmed with the medications and information they received at discharge, that it takes a 60 minute visit to walk them through it all. You start to see how financial incentives insurance companies, including Medicare and Medicaid, place on the practice of medicine affects patients utilization of health services and ultimately increasing the cost of care.
At the same time, practicing Direct Primary Care, allows you to look behind the game. You start to understand and see the real cost of health services. It is infuriating and almost a crime. The greed is sickening. You become bold, confident, and walk a little taller because you are armed with knowledge and experience. Most physicians have no idea what the true cost of care is and shrug their shoulders when you ask them. Most of them are too burnt out or have not had time to really learn the system - but I do not like that excuse of not having time.
We all make time for anything we prioritize. We all are busy, but if we prioritize something or make it necessary, it will be done.
To truly impact the health of our nation, physicians are going to have to get uncomfortable, grind, get out of their comfort zone, fight, speak, yell, do everything and anything we can to change policy. If this sounds like too much, then medicine is not for you. Being a physician is a responsibility. You are responsible for the health of our world. In this global economy and world of social media, we all are interconnected. We are one people, each with individual talents, skills, experiences, and backgrounds. To heal, means to understand the human spirit and seek opportunities to improve health through better housing, better jobs, innovative treatment options, prevention, counseling, and simply listening. That is what makes this profession so beautiful.
Wishing you all great health and happiness,
"He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all."