Family Medicine Vital Signs

By John Houchins, MD

For most of you reading this post, when you participate in our health care system it is on the provider side. If you participate on the consumer side, it is more often for preventive services than for acute care. When I participate, it is most often in the ways described above. However, recently I had a different experience and I found it very important to have this other perspective to get me thinking of the real and dire consequences of our quirky, dysfunctional, and cruel health care system in the United States.

This is what happened: My youngest son, Sean, was visiting from Washington, DC over the holidays. This annual excursion for him always includes a couple of days enjoying the great skiing our locale has to offer and which he gets none of on the east coast. He put an exclamation point on his last run of the last day by having a close encounter of the painful kind with a pinion pine just above Snake Creek lift at Brighton Ski Resort. The result was a plafond fracture of the tibia – which basically means it was shattered into many pieces scattered in every direction. I arrived at the ski clinic just as his toboggan was pulling in. He was being peppered with medical questions: “How did this happen?” “Can you feel your toes?” “Where does it hurt?”. I was being asked financial questions: “Are you the party responsible for medical expenses?”, “Can I have a copy of your insurance card?”, “Do you want a ‘full’ evaluation – including X-rays?”.

The next step was to hook him up with a surgeon for evaluation and contemplation of surgery. At his office, the total body of inquiries by the army of inquisitors there had a lot more to do with ability to pay than ability to heal. Don’t get me wrong – he received exceptional care by the entire team, but if an outside observer had witnessed the interaction with my son they would have been just as likely to conclude that it was more a financial one than a medical one. What was so striking also was that once I was able to flash both my insurance card and credit card, the tone of the questioning became noticeably more congenial. There was a palpable release of tension and (I think) an audible sigh of relief. For my part, for some reason I was hyper-aware of how fortunate I was to be in the position of NOT having to make a lot of difficult decisions about getting my son’s injury cared for. When the issue arose about whether or not to do a CT scan to better evaluate the fracture, I did not have to balance the expense of that against the cost of buying food this week. When the most timely performance of the CT scan and then his surgery required that I travel to sites very remote from the surgeon’s office and at an inconvenient hour, I didn’t have to figure the best form and schedule of public transit or even interact with Uber. I had my own car! When the anesthesiologist proposed a “better, but not essential” type of nerve block for the best pain relief, I didn’t have to think twice over whether this level of service would put my family into bankruptcy.

In summary, even though my son’s injury was a horrendous event, we were able to get it taken care of with the best care American medicine has to offer. He received a first-class evaluation and top notch surgical treatment, all completed within 48 hours of his injury. All of this was possible without delay or financial worry because I have great medical insurance and financial means. The point of this post, however, is not to crow about how great things are for me.  The point is to illustrate what I could not get past throughout this episode: this type of unforeseen medical emergency is devastating to an unacceptably large portion of the residents of this country – the wealthiest nation in the world. In fact, the same can be said of even routine, basic medical care for many people here. This just shouldn’t be so. Our ideal as a nation should be that medical care for everyone should be as convenient and financially worry-free as it was for me and my family.

Here’s the punch line: You, dear readers, are the American healthcare system. My plea is that as you strive to provide the very best care for your patients’ diabetes, heart disease, pregnancies, asthma, childhood development, and the like you also attend to their need – our need–for a responsive and responsible universal healthcare system. Be an advocate, write to your legislators, BE a legislator – do something! It doesn’t change without us.

John Houchins, MD is an associate professor with the Department of Family & Preventive Medicine at the University of Utah School of Medicine.