The American healthcare system has shifted along with the American economy and American society. Long gone are the days of house calls by doctors, pharmacists who will have a long chat with you about medicine interactions, and insurance policies that covered everything. Going fast is affordable health care, the ability to see a doctor on the day you need to, and being able to call your doctor’s office instead of a call center. Health Insurance continues to increase in price, as do medical bills. More and more people are being forced to rely on urgent care, or even the emergency room to treat issues that used to be treated by their own doctors. Visiting urgent care or the ER costs even more and also helps to overwhelm the healthcare system even more than it already is. Primary care is being centralized into hospital groups, making it seem even more impersonal and harder to schedule.
Even when you do get an appointment at your doctor’s office, you’ll likely see a PA and may never see the doctor or any specialist. The American healthcare system CAN be the greatest in the World- when it works. We have the best specialists, the best equipment, the best hospitals, and the best doctors. Unfortunately, both the health care system and the insurance systems are in transition and it would serve you well to plan your own health future and not rely on your doctor’s office to do it for you. Doctors are overworked, there aren’t enough of them graduating from medical schools, and primary care is shrinking in popularity as a specialty among those who do. The continued centralization and corporatization of primary care just make it that much more unappealing for new doctors. There are obvious exceptions- those that go into primary care and resist centralization in order to make a difference in the world. Unless those doctors are independent, though, the pressure is on them to see up to 50 patients a day- a number that makes any meaningful conversation about your health virtually impossible at the primary care level. Even if your doctor is independent, unless they have a different model, they may very well still choose to see far too many patients a day just for the bottom-line.
Aside from the inability to have a real health conversation with your doctor, schedule overload means that doctors rarely have time to really keep up with health trends, new treatments, revised protocols, new studies on the harms of some prescription drugs, or the efficacy of natural ones. Beyond required continuing education hours, some primary care doctors may not read a single medical review and get new information solely from drug reps. We’re in a golden age of medical studies- genetics, natural treatments, studying traditional medicines with modern eyes, and understanding basic biochemical, pathogenic, allergic, and other reactions is at an all-time high. There have been great leaps forward in understanding just how interconnected the various systems in the body are, and how what we eat truly makes us what we are through our microbiomes, for example. These revolutions in knowledge and thinking have bypassed many doctors- particularly primary care doctors- partly because of how overwhelmed they are with the new status quo.
American medicine is undergoing the same sort of revolution the American economy has undergone- seismic shifts that have meant that people have had to become more self-reliant to put together a successful career for themselves. Many white-collar workers used to have job security and benefits that extended from their hire date to the grave. Good insurance, pensions, and other benefits meant that many workers changed jobs infrequently if at all. Many blue-collar workers enjoyed somewhat similar privileges because of the efforts of robust unions. Those days are also mostly gone. Private sector pensions and generous insurance is generally a thing of the past, as is job security. Many workers have had to create their own opportunities through entrepreneurship, multiple jobs, the gig economy, consulting, and just generally figuring it out for themselves. There is certainly opportunity there- the United States is rich and prosperous compared to most of the World, but you can’t take it for granted. You have to inform yourself in order to empower yourself to make the choices that will allow you to succeed. There is rarely someone to do it for you and allow you to advance your career merely through one channel. You have to seize the day.
The same is true of your health. Many of us don’t yet realize that the system won’t take care of us unless we are our own advocates and knowledge banks. Even then, it may be too expensive to wait until we have a condition before we take action. It’s not unusual to hear of patients that are more knowledgeable of their own conditions than their doctors are. Those doctors haven’t had the time to learn, or are stuck in the past when it comes to hard-to-diagnose conditions like Lyme Disease, autoimmune conditions, Chronic Fatigue Syndrome, Long COVID, or a debilitating reaction to an antibiotic that causes long-term damage. There are many other conditions that fit into these categories, and every person is unique. The system can move slowly, you may have to see multiple doctors before you are taken seriously, and the costs escalate. Just as you may have had to study, plan, and make the hard decisions as your own boss and explore facets of the economy and business you didn’t know before, the time has come to do the same with your health. YOU should be the CEO of your own health. How? Again, think of the transitions that people have had to make in business and career and think likewise. Here are some ideas to get you started: