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The shock of encountering the American medical establishment

In the last five years, I have turned into the kind of person I never wanted to be, namely, a voracious consumer of medical services and an immense liability to my insurers.

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Khol editorials

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A lifelong nonsmoker, weight watcher, marathon runner, and jogger, I have nevertheless in quick succession fallen victim first to a near-fatal case of pneumonia followed by another serious affliction, the details of which I won't describe here.

What I have discovered through all of this is that, ironically, one of the strokes of bad luck that can befall a sick person is to live near a prestigious top-tier hospital and come under the care of their revered doctors, who often double as faculty members at affiliated medical schools. The basis of the irony is that hospitals today compete with each other just as ferociously as General Motors competes with Ford or Toyota. If you need a service that is profitable and likely to enhance the prestige of a hospital and its staff, these top-tier institutions are what you want. Patients needing organ transplants and joint replacements are typical of those whom prestigious hospitals like to see. Lower-key lingering maladies put you in the category of just so much meat being processed through the factory.

During two lengthy stays as an in-patient, service during the day was first rate. At night, when much of the care is left to nurses' aides, care is pretty much on the level of a Third-World nation, and to say that is an insult to the Third World. Bear in mind that here I am talking about a prestigious "teaching" hospital.

Also, with most doctors now being in group practices managed by bottom-line oriented financial people, the pressure for profitable performance drives physicians to take on absurd caseloads. When people talk about the horrors of socialized medicine in Canada, one of the things they cite is the month-long wait for doctor appointments. Well, surprise. Here in the United States, the waiting list for one specialist I see runs seven weeks.

I am now regularly seeing two specialists, and in their presence, I get the impression I am a player in the short-attention-span theatre. I see each doctor approximately every six weeks, and when he enters the examination room, he opens my file, which is the first time anyone has looked at it since my last visit. I have to take it upon myself to bring him up to speed and explain why I am there to see him.

The most significant factor that seems to inflate costs and degrade quality of medical care is the maniacal contest between prestigious teaching hospitals. This contest embodies both national ranking and status within their service areas, which often are global. One of the two nationally ranked hospitals in my area routinely attracts royalty and government leaders from around the world. To finance its leap to that exalted status, however, the institution is now 1 billion dollars in debt. Yes, I said 1 billion.

The other hospital, the one I visit frequently, is in just a little better shape financially. It is $359 million in debt but recently had its bonds elevated from junk status to investment grade, a major coup. The prevailing attitude among major hospitals seems to be that they must keep growing into ever-more-homogenous organizations, or they die.

While economics has much to do with the equation, another and more intangible aspect is the way egos drive this insane syndrome. If a hospital is not named the "top" institution in town, its management fears its high-profile surgeons and researchers will leave. Without them, there will be fewer of the highly costly procedures or lucrative research contracts that bring in the most revenue. The major hospitals in my area try to sign up nationally known doctors the way professional sports teams go after star free agents.

-- Ronald Khol, Editor
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