Fix Primary Care (Part 2): A Personal Experience Says It All About Our Failing Health Care "System"
My journey through the healthcare non-system continues with a typically bad customer service experience. We won't make America healthier until we address the fundamental flaws folks face every day.
—Courtesy of ChatGPT
PART TWO (See here for Part One, which appeared yesterday)
The Experience
I finally had to cave and sign up for the weight loss lifestyle program and the linked app. Yesterday was my D-Day, with the “D” standing for disaster:
Well over two hours of my time, and I still don’t have an appointment with a “provider” (I am told I have one; I have not been told who it is or where it is. Maybe Minnesota? It’s a secret!) to help me on my weight loss journey. But even though I have jumped through the hoops and don’t have an appointment the company sure has a lot of my personal health information and my personal identifying information (think driver’s license with its data and my insurance card with its information) in their hands.
Let’s not forget:
· I already have a highly qualified primary care physician, someone I know and trust-- someone who knows my medical history, has immediate access to my medical information including all my labs, who knows that I qualified for GLP1 medication, who prescribed it for me, has monitored my progress over time, and advises me on doses, etc.
· My primary care physician also happens to have a special certification in lifestyle medicine. Those are the folks who specialize in topics like weight loss and GLP-1 drugs. They know this stuff.
· Do I really need to have more appointments with another “provider” with more costs that I will have to pay, and more labs that will cost the “system” hundreds of dollars?
· I am engaged in my health care and weight loss program. I am an “activated patient” fully committed to participate in my care.
· I already keep track of my labs, my weight, my daily food intake for each meal. I record my exercise and my steps in real time. (Heck, even you have seen my data records in a recent blog!)
· I have already lost 50 pounds on a GLP-1 medicine
· I am a success story, walking proof that this stuff works.
· Now I am being told I need a “provider” whose name I don’t know, who I can’t choose, who needs all of my medical history and my labs entered into their system one page at a time into a computer system that is not the same one used by the health system that has sent me to these folks in the first place, to “coach” me to success, and who may now give me an appointment scheduled on that damn app on my phone—and app which will probably track me wherever I go every minute of every day to make sure I don’t go to Popeye’s for some fried chicken.
· Oh, and they want me to—you guessed it—record all the same information every day that I already record elsewhere, since the various apps don’t share data with each other.
· To make things more enjoyable, they want me to use my insurance to pay for all of this, including some more lab tests that I neither need nor want nor will make a damn bit of difference in what they do for me, improve my journey, or improve my health.
My oh my oh my oh my… I can’t wait. I am overcome with joy and anticipation. We are bound for success (not !!!!!).
What we are really doing is wasting my time and my money. They are further dividing my medical care into another bucket, another silo, that will not effectively coordinate with my physician who like me doesn’t have the time to deal with this.
It gets better:
After spending about 90 minutes filling out all the information on their app (They don’t have a companion program available for my computer—which would have made it somewhat easier to enter the volume of information they required) I needed to find out why I couldn’t schedule my appointment to meet their requirement for them to approve my insurance coverage for the GLP-1 medicine.
I picked up the phone and called “customer service” to find out why I was having difficulty getting that appointment.
The bot that answered my call told me I was the 20th caller in line for help—at about 5:30 PM. 30 minutes later, at 6PM, their customer service line closes.
You guessed it again: I had no customer service. I hung up the phone—my dogs had to go outside to pee.
So much for “We are here to help you achieve success with your weight loss journey!!!”
I will likely have to reenter the “customer service” wait list again tomorrow or next week. I won’t be able to leave my house to walk the dogs while waiting for the customer non-service team. I am living right now in a rural location which has no cell service outside of the actual house. It is in a beautiful, isolated location. Cell phone signals don’t reach here.
Consequently, I am tied to my desk and my phone waiting for them to answer the call which means I will have less time to walk the dogs. That means I will take fewer steps during the day in my effort to stay healthy and burn calories.
There is no free lunch these days. It's a vicious—not virtuous—circle, without any respect for me, my time, my other commitments, my needs, or my expectations. Those considerations are not part of their service plan, concern or focus. Nope: delay and deny once again rules the day.
Let’s summarize:
· I have a wonderful primary care physician who knows me and prescribed the GLP1medication appropriately according to guidelines.
· My insurance covers most of the cost.
· I do all the things I am supposed to do regarding behavior change to lose weight successfully.
· I tolerate the medicines.
· My labs, my symptoms, my capacity to do my daily activities all confirm the improvement in my health.
· I have been successful getting to a normal weight after 75 frustrating years (my years before the age of four don’t count). First time ever for me.
Nope. That isn’t enough.
· I must jump through more administrative hoops.
· I must duplicate everything I have already done and continue to do to achieve success.
· I have no assurance which medication I will be able to take, or whether I will be able to get any at all.
· I have spent hours of my time doing stuff I shouldn’t have to do.
What is wrong with this picture?
Although this is just one person’s story about one specific illness and surrounding events, it is emblematic in so many ways of what is wrong with health care today.
Overweight and obesity are illnesses, not choices. They are just like hypertension, diabetes and heart disease. Just like those chronic diseases, we could avoid much of the tragedy if we put our efforts into preventing and treating them in the first place. The new GLP-1 medicines could and should be a key part of that effort.
What do we do instead?
· Instead of preventing disease, we create barriers to access, affordability and availability.
· That turns people off and makes prevention a tough “sell.”
· We make patients, families and clinicians jump through hoops to get effective medicines.
· Every January we go through the charade of meeting the demands of the ever-changing insurance company and pharmacy benefit manager drug formularies--even if patients have their condition controlled on what they were taking last week or last year(s).
· We require “step therapies” because the insurers claim clinicians don’t know which medicines are the best for their patients, while the insurer says it knows better what the right treatment choice is most effective for patients, their care, and their health.
(That the insurance companies contract with PBM’s to pay less for their “preferred” medicines is a mere footnote to their efforts to steer patients to the cheapest alternative. Oh, sorry! I shouldn’t say “cheap.” Instead, I should be politically correct and say, “least expensive and most effective”. Guess I forgot my manners as I was writing this. Wonder why…)
Tragically, this story and similar experiences are repeated countless times, every day, everywhere in this nation.
It’s not just a story about one person suffering from being overweight or obese. It is about the treatment of many illnesses and the barriers put into place as we try to address our epidemic of chronic disease or even—perish the thought—prevent it in the first place.
And you want to make America healthy again? Really?
To repeat my plea:
Mr. Secretary, fix primary care!
Americans are mad as hell and don’t want to take it anymore.
The public knows their healthcare is no longer working for them, and as a result they no longer trust it. Maybe the public shouldn’t trust their lying eyes, what they see and what they experience every day. The healthcare system is no longer providing them the care they want and the care they need. They are not ignorant to the reality of what is happening here.
We aren’t going to go back to the days of Dr. Welby, and we probably shouldn’t. But we can embrace some of those lessons of the past and do much better caring for hard-working folks and seniors than we are doing right now.
Once again, let me remind you that there exist in the background of this woeful tale long histories of policies and procedures that have brought us to this place.
I know those policies and procedures:
I have been there virtually every step of the way over the past five decades. I have been involved in health care as a physician, a patient and as an advocate. I have seen it all, I have argued it all, I have even had a role trying to make things better.
We have failed.
Why am I sharing my story? Because I want to make much larger points:
Mr. Kennedy, your approach to health isn’t going to make America healthy:
· You are focused on the wrong things.
· Your antagonism towards vaccines is dangerous.
· Your efforts to get artificial coloring out of our Froot Loops is admirable, but woefully insufficient to improve the health of the larger population in a meaningful, measurable way.
· Your belief in personal responsibility is laudatory but insufficient to solve the problems we face getting the American people healthy.
· The problems are much larger than your focused, well-practiced, convenient and personally familiar/comfortable talking points.
· You won’t tackle the big, genuine problems, because you can’t. You don’t know the background, the history, or the issues. That “everything else” is a lot more complicated than food dyes and microplastics.
· You don’t have the experience or the bandwidth to tackle the much larger issues that have faced us for decades.
· We aren’t going to come out of this disastrous non-system of primary care medicine any healthier as a nation than when you started messing with it because that is not your focus and is not in line with your personal goals and worldview.
Quite honestly, I don’t think there ARE solutions out there that one person can achieve in a couple of years. Our system simply isn’t built that way:
· We continue to reward procedures, not patience (“patience” is a deliberate word choice) and prevention.
· We build castles to profitable medical services (think the huge, beautiful, new, well-designed office/hospital building housing orthopedic medicine for the mega-health system which provides my care).
· The primary care team is fortunate to have a relatively spartan waiting room and some cubby holes in a basement just down the hall from the laboratory and the rest rooms. No big picture windows lining the wall and bathing the hallways in sunlight with soft wood tone furniture, looking out over a bucolic space, for the primary care folks. No, indeedy! They get the windowless basement location. (Even my wife the gynecologist has a window that looks out into the world.)
No, we are in serious trouble when it comes to making America healthy (forget the again: it was never genuinely healthy in the first place).
Another inconvenient reality is that a major barrier to changing the health of the population is the population. And now, the “system” has conspired to make it even more expensive, more difficult and much less rewarding.
Right now, I need to get back to that non-customer service phone call. My weight loss journey and my insurance coverage depend on it.
One more demand, one more requirement, one more waste of my time. Does it ever end?????
Maybe I need to join Mr. Musk on his trip to Mars. Their customer care must be better there than what we have here.
Elon, are you listening?