European Stars And Stripes (Newspaper) - August 19, 1988, Darmstadt, Hesse                                Too Many patients often feel they Are caught in a system that fails to Deal with them As suffering humans. Unhappy patients fed up doctors by Victor Cohn the Washington Post e very now and then a doctor writes As one did last month to this effect i am really getting fed up with your continue scapegoating of doctors who As a groupware the Best trained closest regulated least burned out but the most maligned and vilified of any vocational  in response to recent columns on the new managed care with its limits on what doctors May do and patients May receive James f. Doherty president of group health association of America the hmm Trade group writes " you would serve readers much better by writing on the sweeping crisis in health care instead of dwelling on the fears of a few practitioners expansion and innovation of managed care concepts May Well Lead to the preservation of the High Quality of american  i agree i also believe that physicians Are often unfairly scapegoated. There Are Many Good hard working doctors. The mos health maintenance organizations that Doherty represents and other purveyors of managed care May indeed preserve the Best of care if they can balance Cost control with humane care. But poignant letters about the failings of doctors and care managers continue to arrive and As Long As they do the caregivers must listen. True when we Are sick and the care in t working we May unfairly tend to blame those who Are treating us. Yet too Many patients now feel they Are caught in an increasingly inexorable and uncaring system that fails to Deal with them As suffering humans. Ellen Reardon a Columbia research geneticist writes of the plight of the chronically ill person who has had repeated Hospital admissions operations or treatments whose self esteem is Low from repeated assaults on personal  picture she says such a person being led to their 37th Slaughter. The physician enters dismisses the body except for the area of his own expertise looks and pronounces the recipe which insures a cure. Questions Are met with you did t hear me or you Don t understand or How dare you question me the patient remember has been this route before. He May be curious about a change in protocols anxious or frightened. Imagine the difference a sensitive and concerned physician could make if Only to provide Comfort and reassurance. Enter the insurance Carrier she goes on. Necessary services May not be provided continuously because they Are not covered or Are covered Only for a limited time. Frequently family and friends provide those but often they cannot. When Hospital admission is advised it is the insurance Carrier that determines the duration of the stay. Statistics prove that patients will recover in a set number of  but the patient May not have recovered. If so she says a Good doctor must insist on a longer stay in the interest of patient welfare not simply complying to save Money for the  this can happen she says revealing that she writes from personal experience. For i recently had a discussion with my disabled husband s new physician in which he agreed that an insurer s ruling was not Good medical practice and won. I wonder How Many patients have received less than optimal care she concludes because they believed that the doctor had their Best interest at heart when he or she simply said Well have to discharge you now " doctors themselves Are giving this subject much discussion and they Are not the Only ones. Gail Wilensky a skilled and humane health economist and vice president of health affairs for project Hope says that medical care has become so costly that there is a need to control both prices and Quantity meaning the amount of care especially expensive care that is delivered. We need to control Quantity she writes through such mechanisms As preadmission screening of potential Hospital patients second opinions before surgery or other costly procedures and concurrent review of length of Hospital stays. In Short managed care. And finally she adds we will of course need to be concerned about the Impact of reforms on the Quality of patient  a Midwest woman writes of a doctor who kept her husband sitting in his waiting room for 21/2 hours though she had told his nurse that Jack had severe Chest pains All  Jack told his wife later that i could t sit still the pain was so bad. Everybody stared at  when the doctor did see him he diagnosed a heart attack. The patient spent several Days in the Hospital was discharged then died. The Long wait in the doctor s office May have had nothing to do with the outcome. Yet there was the wait. And says this bereaved wife or. And Jack and i were friends. He did t Send a sympathy card. He did t come to the Wake. I m so Hurt and  we can t wave a magic Wand to make every doctor sensitive but we can say when there is severe Chest pain Don t sit quietly anyplace for 21/2 hours. From the excellent easily understood take care of yourself the consumer s guide to medical care third edition Addison Wesley $14.95 by drs. Donald Vickery and James Fries there Are no absolute rules about when to suspect a heart attack but the following guidelines usually work. While heart pain May be mild it is usually intense. Sometimes a feeling of pressure or squeezing on the Chest is More prominent than actual pain. Almost always the pain or discomfort will be Felt inside the breastbone. It May also be Felt in the jaw or Down the inner part of either Arm. There May be nausea sweating dizziness or shortness of  these authors sum up if there is Chest pain associated with shortness of breath or irregular pulse or sweating or dizziness or severe pain see a doctor now which in practice usually Means get to a Hospital emergency room. And not a doctor s waiting room As your doctor will almost certainly Tell you. The doctor who wrote that he was fed up with scapegoating is John Harold lossing a Washington neurologist. He also has something to say about the waiting problem from his viewpoint quite honestly it is impossible to maintain a schedule in a doctor s office for several reasons "1. At least one third of the patients Are late varying from minutes to hours to Days. It is very Nice. To recommend that we have such patients reschedule but in practice the prime objective of medical care is Best served by working them in when they actually show up. "2. Emergencies do arise entirely unpredictably. "3. Patients once they get in the consultation room can easily demand twice the allotted appointment time legitimately and must be  Okay we patients say but if we re in the waiting room just let us know that there will be a wait and Why. Many patients say this Seldom happens. Lossing goes on i reviewed my schedule for last week. Of 30 scheduled patients six did t show up at All or cancelled on the same Day of the appointment. On one Day alone four of 13 failed to show up despite reminder Calls the Day before. I have one patient who has missed Over 12 appointments without cancelling. He needs me More than i need him and i am Happy to see him when he does come. " on another Day four patients showed up an average of 37 minutes late one did t show up at All and a True emergency was handled. Although my lunch hour was wiped out earlier a later no show permitted me to Type this  in Short patients too have obligations. Page 16 the stars and stripes Friday August 19,1988