The Emerald Rose

How, Why, andWhen did it “fail”us you ask?

As the preface of the old poem goes, “Listen my children, and you shall hear, of the midnight ride of our Healthcare!”

Part I – So you want to be a Doctor!

Being a Doctor was and always will be a noble profession. How can WE fault a fellow human being, forgoing to college, taking almost impossible workloads, then going into advanced study in Medical School,….and then after all that time, cost and personal sacrifice going for another year of 18 hour days as an Intern, and working yourself to the breaking points of man’s limitation, and after that going into about a two year stint of “Indentured servitude”, also known as ‘Residency” to acquire the hands on personal skills, knowledge, and human aspects of choosing to become a “Healer”.

Friends tell me residency is prolonged work periods, sleep wherever you can grab it, (across several cafeteria chairs, on a table,….virtually anyplace you can stretch out, clothes your eyes and rest,……UNTIL your beeper, cell phone, or the intrusive tones of the PA system jerk your brain back to the real world. Sometimes it’s only minutes of sleep between “intrusions”,…….but you never quit, you push on, and try to picture a warm bed, a fluffy pillow and no electronic devices within a mile of you! That , my friends is pure dedication,…for a noble cause. Beyond that “general pattern”, are the various and burdensome hours of developing a particular segment, or specialty.

Some folks stopped there, had a “shingle” made to hang out side that said Something like “Doctor Robert O’Brian, General Practitioner” and waited for the folks who needed care and help to come to them. (The wait was never very long, and come they did!) Later when the Doctor looked up he noted thirty years had gone by, and another sign below his own shingle that said “Not accepting patients at this time”

A new series of factors surfaced after WWII, “Health Insurance”, and with the insurances which now paid the Doctor, came paperwork, in addition to the “Nurse” who worked for the Doctor was a whole new entourage of “Office Staff”, some were called “secretaries”, some “bookkeepers”, and so it began. BUSINESS started “imposing” on care giving. Along came Insurance company “policies and regulations”, then State and Federal “Policies and Regulations”. The simple insurance for to send in in order to get paid, turned into a whole new job description, and “Coders” were mandatory if you wanted to get paid by the Insurance Company!

The insurance company had to get paid as well, they began dictating costs, incomes based on procedures done and services rendered, and the Doctor needed more “professionally qualified coders” in order to get the proper amounts of money paid to him. Things like “HOUSE CALLS” became as foreign and growing as the Do-DO Bird. (The doctor could make more $$$$ scuttling about the three examining rooms he now had to build onto his house to see patients, the going to see the Smith kids at home to diagnose Measles, Mumps, or Chicken Pox! Now the Doctor had TWO income streams, Office Visits, AND House Calls, usually late late afternoon into supper and usually ending by 8pm.

But if the “coders” in the Doctors office entered the code for Migraine Headache, well the Doctor got paid more than if they just used the code for “Headache”! Hence the larcenous soul of otherwise the noble Healer was dragged into the “little” difference of putting down the higher diagnosis and healing components, I.e. prescription medicine.

Personal Example: As kid there were always “rounds” of colds, flu, ear aches, sore throats etc. going on and then repeating. Any type of “bacterial” situation was treated with penicillin or it’s offshoots and derivatives, like Amoxocylin. I remember having to take the bus down to the local pharmacy, give the Prescription to Mr. Burke’s he would go behind the half wall up on a platform behind the counter, go to get a couple of other bottles, mix and blend them and come out with the little brown glass bottle with the white cap that screwed on, (NOTE: no “child safe” cap, parents had enough sense to Put them away on higher shelves than the kids to reach. Mom also now became a “Nurse” and the Doctor would check in to make sure healing was happening, or adjust medications and instructions!

I watched my Doctor’s office go from the Doctor and his wife, to a six person office with a couple of coders, a receptionist, and two secretaries who handled correspondence and filing and other stuff. What was one file cabinet in the corner of the “little exam room” was now a “suite” almost 2000 square feet big, in a “Medical office Building” with twelve other Doctors in the same conundrum.

PART TWO – The Insurance Companies follow this blog tomorrow at “Guinness222.com”. It ain’t over yet!!!

It began in the late 1960’s.