Healthcare in America:  My Father’s Last Five Years

Are we getting what we are paying for?  

I believe that most people would answer, “NO!"

Healthcare, by the numbers…

The US Ranks 37th in the world out of 191

Many Americans are concerned about the state of healthcare in the USA.  Problems related to cost and access are the issues most often cited regarding USA healthcare.  The USA is the only developed country in the world without a system of universal healthcare.  However the USA spends more on healthcare than any other country.  The USA comes in first in the amount of dollars per capita spent on healthcare.  Health expenditures per person in the USA were $12,555 in 2022, which was over $4,000 more than any other high-income nation. The average amount spent on health per person in comparable countries ($6,651) is about half of what the USA spends per person.  

Studies show that the US doesn’t come close to the top rankings in the world. In fact, it ranks 37 out of 191. 

When the World Health Organization carried out their analysis of the world's health systems in February 2000, they found that France provided the best overall healthcare followed by Italy, Spain, Oman, Austria and Japan. Legatum Health Index (2023) ranked Singapore at the top, scoring 86.9 points out of 100. The US scored 73.3.  

The Legatum statistics revealed other countries who had higher rankings than the US which included China, Australia, Canada and even Cuba.  However, it should be noted that the US ranks first in the use of science and technology for healthcare innovation.

How do these statistics impact your care?

I was a hospital consultant for 40 yearsa and I want to share what my years of experience in the healthcare field have taught me and the problems they have exposed. If you understand more clearly what the problems are in the healthcare industry who serve you and what to expect, you can be more prepared to navigate proactively. If a professional like me can get blindsided, what chance does the everyday person have?

Over the next year I will use this platform to write about the challenges and what you can do about them, answer your questions and spill the beans.

Let’s talk about what the problems are.

My Dad’s Story

I will share my Dad’s story and what happened to him in the last five years of his life.  

My Dad was diagnosed with congestive heart failure after he and my mother had moved to California to be closer to family.  On the day he arrived, he found himself in the emergency room experiencing breathing problems.  It was exactly 5 years later that my father died of CHF.  

During those last five years, he was hospitalized approximately 20 times, many of which required intensive care. There were three doctors in charge; a cardiologist, an electrocardiologist and finally a neurologist for the Parkinson’s he developed 2 years later.

Navigating Healthcare 

What are the problems?

Problem #1 

Lack of Prescription Tracking

One of the problems that we experienced was the inability to track prescriptions. Surprisingly, there was no system. The healthcare providers and even the hospital relied upon my Dad to keep track of what was quite a list of evolving medications. My Dad would print out an updated list each time there was a change and stuffed it into his billfold.  Every time he went to a doctor’s appointment or to the hospital, he was asked what medications he was on.  He would reach into his billfold and produce his list.  The doctors had no ability to cross check for possible interactions between drugs because no one talked to each other and there was no central records system to refer to. The patient or family caregiver is the one who fills this gap.

However, since September 2001, Canada has had the National Prescription Drug Utilization Information System (NPDUIS) in place which allowed authorized healthcare providers to access and manage all medication information.

In Australia, doctors, nurse practitioners and pharmacists who are caring for a patient are authorized by law to access their patient's records using a system called SafeScript. 

At present in the US, there is no national system to track patient medications. Some states have, however, established databases to track the prescription of controlled medications. 

 A 2019 article in American Family Physician states, “Communication between primary care physicians and subspecialist physicians is critical to mutually understand the goals of drug therapy and to avoid or modify drug combinations that may put patients at risk.”   In that same article it was stated that “drug interactions are estimated to cause approximately 2.8% of all hospitalizations annually in the United States, representing more than 245,000 hospitalizations, costing the health care system $1.3 billion.”  

When it comes to medications, the lack of communication is a big problem in the US.  Tracking a patient’s medications and spanning the gap between doctors is currently the responsibility of the patient or family caregiver. 

Problem #2

Doctors Maximizing Reimbursement Payments

Throughout my Dad’s last five years, there were many doctor visits, many of which I felt were unnecessary.  

EXAMPLE

Let's say that you go to the doctor for a routine visit and he/she orders blood tests.  You then go to the lab to take the tests, and results are then forwarded to the physician.  Another appointment is scheduled to review the results regardless of whether there is a medical issue that needs attention.  

Transporting an elderly person to the doctor where they may be potentially exposed to other illnesses is not only a waste of everyone’s time, but can have a dangerous ripple effect. Requiring this additional visit is a cruel reality in our current system of care. The one who benefits is the doctor, not the patient. 

This also happened to me…

It was May 2022, and I needed to have a series of cardiac tests which were performed at various locations.  Each visit required a Covid test.  And of course, the only place they would allow me to take the Covid test was at the doctor’s office who ordered the tests. I was not allowed the convenience of using a nearby Quest lab right around the corner. 

 Why?  Reimbursement.

Problem #3

Recognition of Decline and the Emotional Care Gap

I have worked in healthcare, very closely with doctors, for 40 years.  I learned early in my career that some doctors have a hard time communicating with patients about their diseases and probable outcomes.  For the most part, doctors are educated on how to cure disease, not the emotional aspects of how to help patients transition through the end of their life.  

However, this was officially recognised by the American Board of Medical Specialties adding the specialties of hospice and palliative care in 2006.  But sadly, even today, most know very little about this incredible service. Even though Hospice may be called in 6 months prior to death, very few do. Why? Doctors do not talk about or coordinate with families on the benefits of Hospice. You must discover it on your own. and you don’t know what you don’t know.

Dying is part of life. Talking openly about it and getting the help that you need to make this transition peacefully is a precious responsibility each family bears. Comforting someone you love when they are dying is as important as saving their life in an emergency. 

Problem #4

Cognitive Dissonance and Denial

From the beginning, my Mother was determined that my Dad would “get well.”  So there was never any discussion about his actual prognosis. This created a void in me that I could never fill.  Doctor’s do not learn how to discuss death. The many emotions that surface during this time most often go unexpressed. Precious goodbyes are missed.

 As time went on, it became apparent to me that all the medications, the insertion of the pacemaker, then the defibrillator, the admissions to the ICU, etc. were not making him well.  

Working  as a consultant and traveling every week all over the US made me worry that something might happen when I was out of town. I did the unthinkable.  I called his cardiologist and asked him about my father’s prognosis.  I could not get a straight answer. He fumbled around uncomfortably and finally said that 50% of CHF patients die in five years.  Five years was only two months away by then. My Dad died just a few days short of the five year prognosis.  

I was in Philadelphia when I got the call. Without warning, the hospital had suddenly released my Dad from the hospital, sending him home for hospice care.  I left Philadelphia right away, but by the time I got home, he was in a drug-induced coma and died three days later. 

If I Only Knew…

I never got to say goodbye and tell him how much I loved him and what a great father he had been to me.  I have often wondered how he might have spent his last five years had he known that he would ultimately not recover from CHF.  What might he have done differently if he had known that statistically his time was limited?  Maybe his doctors were waiting for him to have asked the question about how long he might have to live - but I think that they should have initiated the discussion.

Future Topics

Navigating the emergency room 
When to use an urgent care
What to consider when selecting a doctor for yourself or your loved ones
Falls in the hospital

I look forward to having these discussions with you … in the meantime, TAKE CARE!