Access to care is absolutely critical in the overall management of patient. When I first started medical school, I didn’t realize how much of medicine was finding the right medicines that the insurance would cover or that the hospital was willing to offer based on their own agreements. I believe that the team should work together to make sure that the patient still gets the best standard of care despite these financial constraints.
One poignant example early in medical school was during transitions of care from one doctor to another. I encountered a patient that had recently been transferred to an OSU doctor from her former life-long doctor, who used paper charts. The transition was rough due to the system limitations of paper charts being very difficult to read and the patient not knowing what drugs she was supposed to take. By the time, some of her medications were maximized she had learned that OSU was going to drop her insurance and that she wouldn’t be able to come to OSU anymore. The patient felt betrayed. She felt that OSU would be the best place for her care because of the rapport with the new doctor and how close it was to her home.
Attached is a link to my Advanced Competency Capstone that talked about one of the determinants of health: https://docs.google.com/document/d/1m8wHHJxH6SDe4fLrhB-sINK0_mMocxgKTCmuVUztQCg/edit?usp=sharing
The lesson I learned from this is that the institution often directly affects patient care even multiple levels removed. It seemed to me that this transition in contracts may have made financial sense but had a cost in patient and doctor satisfaction. I think this was also the first time I’ve ever seen the institution of the hospital actively changing patient management by forcing the patient to choose another hospital system. I also could feel the loyalty that patients develop with the doctors and that was really inspiring me in the future. To me, the doctor is the face of the organization to that one patient they care for and I want to represent the organization well in addition to being an advocate for my patient.
I am happy that in the future I will be working for the Air Force after I’m done with my residency. I will be lucky enough to have patients who will all have full access to the hospital and resources without gaps in care due to finances. However, it isn’t perfect. In the military, drugs are often chosen based on price and certain newer drugs may not be covered unless previous ones had been tried first.
During my one military away rotation fourth year, there was a patient whose symptoms were only resolved with the one medication that he was currently on and he had tried multiple others OTC. The one medication was a more expensive drug and could only be prescribed by the military doctors if every other medication up to the cost of that one was tried and failed. The patient was forced to use a drug that had already failed but was about three times cheaper for documentation purposes. I thought this situation was incredibly unfair on the patient as they would be using a sub-optimal drug. This decision was not targeted towards the quality of life metric and focused too much on the cost-effectiveness. In order to try to work around this, the resident and I had to apply for a waiver and then try a few combination of medications to get the effectiveness of the drug the patient was already on.
The system forced a solution that was not optimal for finance reasons but ultimately did have a waiver system that would take some time to fill out and then receive permission for but there was a lot of wasted time and decreased patient outcomes. I had to navigate the system in order to properly do my duty for quality of care. This situation forced me to think that in many cases costs should come secondary to quality of life. During the rest of my fourth year, I worked in rotations for the undeserved to take care of those who are normally left out of the medical system. In the future, I’d want to work for an organization that has great accessibility for every type of patient so I feel that I am able to do the best for the patient.