How Medicine Got So Sick

You arrive at your doctor's office on time and find five patients already crowding the waiting room. You can either reschedule and hope that you'll spend less time in a hardback chair with an out-of-date magazine or kiss half your day goodbye. Grrrrr.

You've had a pain in your side for a week. You figured it was heartburn until it got a lot sharper. You call your physician, but she's booked solid for the next five weeks. If the pain gets worse before then, she says, go to the emergency room. Aaargh.

Your libido unexpectedly takes a nosedive, so you go to the Internet, where you learn that the new medication you only recently began taking could be responsible. You call your doctor to discuss the research only to hear, "It's not the medication, honey. At your age, what do you expect?" Yeooow.

So much about medical care is frustrating and discouraging these days. Wait times for appointments, for instance, can prove lengthy. A study by the Commonwealth Fund, a health-policy group, found that in 2005 only 30 percent of U.S. patients could see a doctor the day they had a problem; 23 percent had to wait six days or longer.

And that's if they can afford it. The 211.5 million of us lucky enough to have private or non-Medicaid government health insurance are paying ever more for the privilege. For example, in 2007 individuals who got insurance from their employer contributed an estimated average of $273 a month for family coverage and $58 a month for single, up from $129 and $27, respectively, in 1999, according to the Henry J. Kaiser Family Foundation and the Health Research & Educational Trust. Among small firms only 59 percent offered health benefits in 2007, down from a decade high of 68 percent in both 2000 and 2001. More of us now have to finance our healthcare entirely out of pocket.

While we shell out more for healthcare, the primary-care doctors who are supposed to be our first call and continuing-care contact have seen their inflation-adjusted pay flatline and malpractice premiums rise. Meanwhile health insurers are pressuring them to increase patient loads, which can force them to overschedule. Clearly, these are not the makings of a satisfying doctor-patient relationship.

But we need that good relationship now more than ever. The new watchword in medicine is "informed decision making." Whether the question is how to reverse prediabetes before it turns into the real thing or whether to have a mastectomy or a lumpectomy for breast cancer, Americans are being asked to take an increasingly active part in making medical choices. "While the caregiver has a heavy responsibility to inform, educate, and actively involve patients and consider their needs and values," says Carol Aschenbrener, MD, executive vice president and head of medical education at the Association of American Medical Colleges, "patient-centered care means the patients need to take more responsibility for self-management."

This special section of Ladies' Home Journal is designed to help you get what you need from your physician despite today's perfect storm of harsh economic forces. You'll see what you have a right to expect -- and what's unrealistic in today's environment. You'll learn how doctors think, so you can make sure you don't get trapped by a medical mind-set that short-shrifts possibilities that could better pinpoint what's wrong with you. You'll get tools to rate your doctor and learn of new solutions helping to improve medical care.

Originally published in Ladies' Home Journal, December 2007.