Recently I was invited to speak to the Raleigh Academy of Medicine. Here is an edited version of my remarks:
During the last five or six years, as my elderly parents were overtaken by illness and disease, our roles reversed from when I was a child. I became their caretaker, which included navigating our health care system.
My parents had a host of ailments, but principally for my mother, a 50-year smoker, it was a chronic, progressive lung disease. For my father, it was Lewy body dementia, which shares some symptoms with Parkinson’s disease, such as tremors and problems with walking or balance.
These are just my observations; I don’t know if others have had a similar experience. Here’s what I learned:
1. No single person in the health care system was in charge of managing and coordinating the treatment for each of my parents.
My parents saw multiple doctors, all highly competent, but those doctors typically did not communicate with one another. Technology promises to improve this communication through universal access to records. But if there was active communication among doctors, I rarely saw it.
What my parents needed was a case manager – and eventually, I realized that case manager would be me. Which was fine. I live here in the same community as my parents did and saw them at least once a week.
I could communicate with doctors and nurses and make sure they knew that my parents had seen other doctors. And I could ask questions so I understood the options for treatment. My wife and I could get my parents to their appointments. So for my parents, it worked.
But what about those elderly people who have no one in town to look after them? Who don’t have anyone who can discuss treatment options with a doctor or nurse? Who will be their case manager?
2. The complexity of our system of health insurance is overwhelming.
I am not smart enough, or patient enough, or both, to navigate health insurance, pay claims and understand what I am paying for and why. I know, as you do, that our system generates large amounts of paper.
Reading and understanding a hospital bill is difficult for a person who is not fluent in the health care system and its procedures and language.
Reading and understanding a hospital bill is difficult for a person who is not fluent in the health-care system and its procedures and language.
Does a visit to the emergency room for what turned out to be a modest amount of treatment really cost several thousand dollars? Maybe it does.
Fortunately, when it came to paying my parents’ bills, my sister, who works in a hospital and understands health insurance, was able to educate me and guide me.
There must be a way to create an insurance system that is less complex and puts incentives in the right places by encouraging all of us to improve our health and fitness.
3. I’ve offered two criticisms of our health care system but want to also offer some well-deserved praise.
I consistently was impressed with the health care professionals who treated my parents. I’m sure I had 100 conversations with doctors, nurses, pharmacists and support staff about my parents. I had only one bad interaction. That was a hospital nurse responsible for my father who had not paid attention to the course of action prescribed by the physician. I’ll chalk that up to a tired nurse with a busy shift.
So if I had 100 interactions with doctors, nurses and other health care professionals in the last six years and one was not good, that’s a customer service success rate of 99 percent. That’s good in any industry and, given the complexity of treating human beings and the 24-hour, 7-day-a-week nature of what you do, that’s impressive.
I wanted to understand my parents’ health issues, and the best way for me to do that was to ask questions of their doctors. I never had to wait more than 24 hours for a physician to return my phone call.
Counting emergency room and hospital visits and the doctors my parents saw regularly, I’ve spoken with at least a dozen physicians in the last few years. Each patiently answered my questions and tried to explain my parents’ various ailments in language that I, as a layman, could understand.
Among them was Dr. Steven Liebowitz, who is here tonight. He saw both of my parents at their retirement community in North Raleigh and kept me updated.
So I want to thank him and all of the other medical professionals who looked after my parents. Their level of professionalism and compassion was very high. I am grateful for that, and for all of you and what you do.