• Increase Font

    The paradox in American healthcare

    Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Stephen C. Schimpff, MD, a quasi-retired internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center, and author.  The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


    We have a real paradox in American healthcare.

    On the one hand, we have exceptionally well-educated and well-trained providers who are committed to our care. We are the envy of the world for our biomedical research prowess; the pharmaceutical, biotechnology and diagnostic equipment industries continuously bring forth lifesaving and disease altering medications, devices and diagnostics. So we can be appropriately awed and proud and pleased at what is available when needed for our care.


    RELATED: Where will the healthcare debate lead us?


    But, on the other hand, we have a very dysfunctional health care delivery system. A fascinating paradox. One wonders just why it is that Americans tolerate this paradox of incredible medical advances and outstanding providers yet a dysfunctional delivery system.

    Our medical care system works poorly for most chronic medical illnesses and it costs far too much. Chronic illnesses are ones like diabetes with complications, cancer, heart failure and neurologic illnesses like stroke and multiple sclerosis.

    These chronic illnesses are increasing in frequency at a very rapid rate. They are largely (although certainly not totally) preventable. Overeating a non-nutritious diet, lack of exercise, chronic stress, and 20% still smoking are the major predisposing causes of these chronic illnesses. Obesity is now a true epidemic with one-third of us overweight and one-third of us frankly obese. The result is high blood pressure, high cholesterol and elevated blood glucose, which combined with the long-term effects of behaviors,  lead to diabetes, heart disease, stroke, chronic lung and kidney disease and cancer.

    And once any of these chronic diseases develops, it usually persists for life (of course some cancers are curable but not so most others). These are complex and expensive diseases to treat—an expense that continues for the rest of the person’s life.


    TRENDING: Doctors' salaries are not the problem behind American healthcare costs


    Primary care physicians (PCP) can deal with most of the issues of these patients—if they have the time to do so. But they do not have the time. They need to see 20-30 patients per day to meet overheads and earn their salary, so appointments are usually 15 minutes and “face time” is about 8-10 minutes.

    That’s enough time for “simple” problems but not for the patients with a chronic illness or two or three who is also taking multiple prescription medications. That patient needs much more time. The PCP needs time to listen carefully, then time to think and to then provide the appropriate care. But without enough time, the tendency is to just refer out to a specialist. This drives up the cost and does not improve quality. Of course there are times when referrals to specialists are necessary. Primary care physicians then need to coordinate that care, but generally do not have the time. Any team needs a quarterback, and in general, that person should be the primary care physician. He or she needs to be the orchestrator as much if not more than the intervener. Coordination is absolutely essential to assure good quality at a reasonable cost.

    Next: "This will lead to much better care and less expensive care"


    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • [email protected]
      wanna use this medium to inform everyone on patient forum ,about traditional medicine. i ordered the herpes herbal medicine from [email protected] an address i saw on vegan recipce on facebook, and received it through ups within 5 days and used it as directed . in just 2 weeks of medication i felt relived, the inching suddenly stopped, the cold sore began to dry up. i went for a text and was HSV 2 negative . same virus the scientific researchers said no definite cure, i endorse traditional herbal medicine for all who are in need of alternative cure.
    • [email protected]
      Thanks again Dr Schimpff for getting it exactly right. My partners and I almost spiraled into burnout after 36 years in primary care seeing 30 patients per day.. Then we converted to Direct Primary Care and have not been this happy in years. No more filing insurance, dealing with Medicare demands, number crunching, numbing reports, and senseless regulations. We work for our patients and not the insurance magnets. We see 10-12 patients per day, enjoy half hour visits, teach, and actually have a grounded relationship with each patient. How wonderful old style is that! We hand each patient a statement and proper coding to file on their own. This works for commercial and Medicare insurance with any reimbursement returning directly to the patient. Instead of quitting our beloved occupation, we will practice longer and happier years. Keep up the good work and writings. A little bit of heaven has returned to central Indiana! Dr Bob

    Latest Tweets Follow