Apathy meets Aggravation

I used to complain about the American medical system. Now that I've experienced working within a socialized medical system, I won't complain anymore. It's not a complaint about the patients. In fact, quite the opposite. They are a lovely group to work with, not very demanding, use to waiting six months to see a specialist, a year to have surgery. They don't know any different system. They continue on, in what I like to call their stably sick situation, riding a fine line between death spiral and life maintenance.

No, it is not the patients. It is the system. As a GP here, I'm meant to be the gatekeeper, keeping these patients stable, referring them on when necessary, being their advocate every step of the way. As the gatekeeper, I often find the gates are closed. I can't prescribe the medicines I want, either because they're not available or because they need specialist consent for dispensing, and I can't order the tests I need. It's really the simple things that bother me. After all, I used to teach residents that 90% of diagnoses can be made by history and physical exam alone (boy, am I biting my tongue on those words everyday).

As an example, let's discuss medications for a moment, antibiotics in particular. I'm limited to about twelve I can prescribe, unless I can some how track down a specialist, talk to him on the phone, fax him the information about the drug and clinical situation, and get him to fax back the approval. Granted, the specialists are always willing to help, but I could spend all day on the phone just for one patient. Advocacy has its limits.

Radiology is a totally different story. General xray spans the extent of my ordering, but only on a Monday, Wednesday, or Friday when the radiology tech is actually at the local hospital. Ultrasound, I don't think so. CT or MRI? You've got to be kidding. I had a lady come into the office in the midst of an acute stroke. She waited a week to get a carotid ultrasound, only because I sent her through the emergency department. Not because I could actually order the scan myself. Stably sick.

Thus, I continue on, laughing with the patients, appreciating that they don't understand my frustrations. Knowing that not everything can be American.