#thetorrent

Primary Care Problems

The path of a typical medical student is long and arduous. There is not only the incredible (and, surprisingly, unorganized) memorization of material, but there is also the legendary residency period, where years are spent simply getting used to caring for all age groups. It is not uncommon to spend over 10 years preparing to practice medicine, when combining the required lengths of pre-medical studies, medical school and residency. When they’re finally done and begin practicing, it turns out that new doctors move toward specialized roles at a greater rate than general roles like primary care.

Now, this is a problem. Anybody going to a specialist without knowing exactly what’s wrong will inevitably waste money and time. It’s the job of the primary-care doctor to provide us with an analysis of our problems and refer us to the appropriate specialist. Without them, patients lacking sufficient knowledge are likely to go to the wrong specialists, if they even require a specialist at all. It isn’t uncommon for a patient with a simple condition easily detectable by one visit to a PCP to delay their treatment by attempting to find the someone that could tell them what’s wrong.

Image via Explosm

Why is this happening?

Science and those that practice it are not always on each other’s side, unfortunately. There are stigmas within the medical community about primary-care physicians being less useful and even less capable than specialists. But, besides that, for all the time that doctors spend in school, there is a greater return on their investment if they go into specialized medicine. In fact, orthopedic doctors make twice more than family doctors, according to the 2017 Physician Compensation Report of Medscape.

Graph via Physician’s Weekly

There is another, even more concerning reason for the decrease in PCPs. Remember those poor health and living conditions that I mentioned before? Those drive more patients into the slowly shrinking primary care offices that we have. Said another way, the worse the health conditions of the public become, the more that a primary-care physician will have to deal with.

Two problems result from this that could make physicians stop practicing primary care. First, a small amount of general physicians handling large workloads brings a tragic burnout over time. After all, a lack of a proper balance between work and life is a known cause of burnout. Second, physicians do not spend as much time as they should having face-to-face interaction with their patients. That, to be fair, is depressing; when your livelihood is about people, not spending that time with people can be disheartening, especially when they have a grave issue. Both of these are catalysts for the departure of a primary-care physician.

With a decrease in the amount of family doctors coming in, and an increase in those leaving due to both the aforementioned problems and older physicians reaching retirement age, the primary care field is suffering.

The bottom line is this: PCPs are, unjustly, in a similar state as to if they were never valuable at all. The loss of these first-line-of-attack doctors will, without a doubt, increase mortality rates. After all, what happens when there isn’t an appropriate doctor to address the incorrect assumption that you found on a Google search?

In any event, one of the solutions to this problem is rectifying the problems that bring so many patients to the office. But an equally effective solution can be found in rectifying the healthcare system.

Necessities to Health

$3.4 trillion dollars.

Can you imagine spending that much? How about if you were, say, the government of the United States?

You probably could imagine spending it in that case. But how about on one thing, such as healthcare? In that case, there’s no need to imagine that. Because, despite other countries having more effective systems and spending less, we still spend that amount of money on our American systems today, surpassing spending on anything else in our nation’s budget.

This collection of data from the Visual Capitalist shows that countries that have become popular to mention by our current administration such as Norway and Canada are spending far less in terms of healthcare per capita than we are.

That statistic, when given alone, means little, but when you take into consideration another stat that I mentioned previously, life expectancy, that means far more. Once again, from the CIA database, we see that, in terms of life expectancy, Canada is 22 places above us in 21st place, and Norway is 25 places above us in 18th place.

The numbers don’t lie – they are spending less per person and living longer. Said more clearly, America, which has a $20 trillion gross domestic product (GDP), meaning it offers $20 trillion worth of products and services, is unsuccessfully throwing more money at a problem for a miniscule improvement when countries like Canada, which has a $1.46 trillion GDP, and Norway, which has an even smaller $405 billion GDP, see much greater returns!

This is an example of efficiency at its finest – something that seems to be lost among this country’s leaders. Maybe there’s a little false pride by the Americans in not being like Norway or Canada, but we should be taking pages from their books, if they’re such great countries, right, Mr. President?

The Healthcare Maelstrom

So what in the world are we spending so much money on?

The answers are health insurance and inflation of drug prices. Let’s take a look at the first.

The administrative costs of managing such an demanding system count up to 8% of our total expenditure. That is because the more private insurance businesses that there are, the more communication is necessary over discussion of coverage, billing, compilation of records, et cetera. Think about how much paperwork you have to fill out regarding your insurance and your health record information when you go to get a checkup. What happens when the doctor is finally ready to see you? They whip out a file containing those documents or a computer with those documents stored digitally.

What are they doing?

The Annals of Internal Medicine, a journal dedicated to internal medicine, answers this very question. After observing 57 US physicians for 430 hours, along multiple disciplines, it is reported that they spent almost 50% of their time looking through health records and other administrative tasks on office days and almost 40% of their time doing the same when working in their respective clinics. Almost half of those physicians also dedicated an additional 1 to 2 hours more to health record tasks.

Remember when I mentioned that physicians don’t spend as much time interacting with their patients face to face? I should amend that: they can’t spend as much time.

So it’s not only healthcare administrators spending most of their time dealing with insurance companies, but also doctors who need to deal with health records. This leads to wasteful spending – we’re essentially paying these groups to organize. That is not what a clinic or hospital should be doing.

With that said, we get to drug prices.

The US dumps a massive amount of money into the pharmaceutical industry, just like we do in the entirety of our healthcare system. That expenditure means that pharmaceutical companies have the means to not only create many types of drugs, frequently, but also influence the prices.

There are many more factors that go into the pricing. Of course, how available the drug is matters, but there are other, less considered factors. Matthew Herper of Forbes indicates that even the failures that don’t make it to market are included in the development cost. In other words, the cost includes a cushion for the company’s failures. Insurance companies also may or may not cover the treatment, changing how, or if, the patient is able to pay for it. Therefore, the price tag, the actual value of which is still being debated to this day, is not only determined by exclusivity of the treatment, but also drug safety testing and insurance coverage.

The bottom line? The US pharma industry sets the rules because there is no other country that has the resources that the US has to create these treatments and set the table.

The Storm Rages

We will all get sick at some point, right? With age, immunity decreases, as you already know. But what happens when you do?

Say that it’s 2060 and we are on the same pace as we are now. You’re, likely, still working, as the prices of drugs are not effectively regulated since government gives the freedom to the pharma industry to set prices and insurance companies are still charging higher and higher premiums and deductibles. You come down with a superbug, some bacterium or virus created because we have become inundated with so many antibiotics that the pathogen, or anything that causes disease, becomes immune.

This superbug requires a new drug to be created to cure, but, as it stands, you will have to take multiple prescriptions just to soothe your symptoms. Finally, after it starts to become an epidemic, one pharmaceutical company out of the many comes with a solution.

Only, the leader of that pharmaceutical company turns out to be a villain, charging those with the condition an exorbitant fee. Why? Because they are in complete control of the industry. Now what do you do?

We don’t even have to ask if that would because it already has. Vice would like you to meet Martin Shkreli.

Image (of this scumbag) via Getty Images

In any event, many will tell you that everything is solvable with a little elbow grease. That healthcare is a privilege that those who work hard have earned. “Pull yourself up by your bootstraps”, right? Well then. To those people, I invite to answer this question for me and for everyone similar to Mr. Savastano, who have worked hard all their lives, and, even when they catch a break, it’s much too late:

The question, for some, is a hypothetical one. They might implicitly understand why science is difficult, but can’t explain it. But for most, that answer doesn’t come easy. And because the answer isn’t easy to discern, the solution is also problematic.

But the answer is simple.

Science is an amalgamation of study since the inception of humanity. We collect new knowledge every day. As such, the depth of information that exists make it hard to widely communicate. This is a problem – one that will catch up to us sooner than later if we do not start putting priority on reviewing how we do things. Sure, it is true that you can amass all science related to chemicals and reactions under chemistry, for example, which segments all of the information and makes it easier for specialists of chemistry to communicate. However, if there’s so much information to digest, why isn’t the equally-deep topic of history divided into more categories than Social Studies, US (or whatever country) History, and World History?

There are inconsistencies with convention. You will, after spending time with me, understand that science is incredibly unconventional.

The main difference between something like history and science is the inability of history to change. Over time, with the addition of new knowledge, the textbooks must be rewritten, as it were. But does splitting the subjects make it easier? I would argue that it doesn’t.

Order to Chaos

I said earlier that a priority should be put on reviewing how we do things, or, in other words, how we organize. Organization could be defined as giving an “order” to something. That order is determined by what makes sense to the general population. We define that as convention, which we use to figure out the unknown by relating it to what is known or to create systems based on what we know. In other words, the system we use to communicate science is according to what made sense to us in the past, whenever science was first organized in this way.

So, there was a purpose in it being organized this way. Where did it go wrong? Do people even believe that it has gone wrong?

Take a walk with me for a second, let’s see.

What happens when a child goes from preschool to college? Simple “math” becomes algebra, geometry, and trigonometry. Then it becomes pre-calculus, calculus, multivariate calculus, and differential equations. Simple “science” becomes biology, chemistry and physics. Then we reach physiology, anatomy, and genetics, organic chemistry, engineering and quantum mechanics. The engineering disciplines take the advanced mathematics and interfaces them with the advanced science. And guess what? That creates new subjects as well. From one, comes multiple. But, as I said, we collect knowledge every day. The subjects that we see here will remain and grow, but there will eventually be newer, more advanced subjects added underneath the respective umbrella. There is beauty in the sequential branching of easier subjects into harder ones…but does that sound like order to you?

Now take the opposite perspective – chaos. Something about the word itself implicitly draws discomfort. There will always be a lack of comfort in disorganization. But your chaos can be someone else’s order. Learning why they consider it order can lead to a breakthrough in your thinking that may be limited by the convention that you have followed. In other words, do not assume that chaos is ineffective; chaos is merely disruption of convention.

I make this quick deviation to make an argument.

While science is implicitly hard to teach due to its own depth, its even harder to learn because what was once simple in elementary school magnifies in difficulty by the time one is in college.

But, if science is on a similar path to that of history, then science, despite the difficulty of doing so, can also be told linearly with as few branches as possible. This defies the order of starting from the simplest topics first, separating them according to their properties and diving deeper into those categories.

What would happen if you started from what we know now as the beginning – the smallest particles of the universe – and worked our way to the farthest reaches of human knowledge? What if, instead of separating science into more topics than necessary, we acknowledged the connection between chemistry, physics and biology from the start, and taught science that way? I figure, by the time you get to the parts of existence that you can see with your own eyes, they will be far easier to understand.

To those that are joining us on this journey, welcome. I can only hope that your stay will be enlightening as we not only explore where we’ve been, but where we must go.