Sunday, June 12, 2011

Self Service Medicine

I wash checking out and bagging my own groceries the other day when I started to think, what happened to the good old days? All this self service is designed to save the store more money and increase its profits. But I miss the recent past when full service was not just an option, but the norm. My brother worked as a bag boy at a grocery store during high school. Back then, he not only bagged the groceries, he even took the bags out to the parking lot and placed them in the customer's car. Rain or shine, snow or stifling heat, he walked back and forth from the store to the parking lot dozens of times a day. The customer never had to get her hands dirty touching the grocery bags. Now some places don't even give you a bag to put your stuff in anymore.

Even further back in history, how about the demise of the full service gas station. I'm not old enough to have experienced it, but I'm told gas stations used to fill up your gas tank for you without you ever getting out of the car. Remember in the movie Back To The Future when Marty McFly is transported back to the 1950's and was astonished to see multiple attendants swarm a car as it pulled into the station? They were filling the tank, washing the windshield, checking fluid levels, filling the tires, and doing whatever it took to make sure the customer had a satisfying experience at the station.

That scene reminds me of the present situation in medicine. When a patient is wheeled into the emergency room, a horde of people descend on him to make sure he is treated to the highest possible standard. From doctors to nurses to techs to secretaries, an entire crew of people are there, costs be damned. But as the government and insurance companies relentlessly cut reimbursements to hospitals and physicians, we maybe headed in the direction of self service medicine in order for the payers to save money, even if it becomes a significant inconvenience for the customer.

Instead of complaining about the $5 tablet of aspirin, what if the patient's family went to Walmart and bought a bottle of the stuff for the same price? Patients complain about the cost of medicine because they don't see all the work that is required to bring that one pill to his bedside. Everything from the pharmacist, to pharmacy delivery, to the nurses, to the little paper cup that is used to bring to medicine to the patient costs money and is factored into that $5 aspirin. By buying the medicine themselves, families can save a lot of money by eliminating the middle man. The doctor just needs to tell the family, or write a prescription, and they can go out and find the cheapest source for their meds.

Think how many other procedures can be made self serve to save money. How about the self serve chest X-ray. What could be harder? You just walk up to a plate, take a deep breath, and push a button. Voila. A chest film. Or perhaps self service vital signs. Just have one of those automated sphygmomanometers at the bedside and have the patient or his family caregiver measure his own vitals. If the patient is unable to take his vitals, of course the hospital's nurse will do it for you, at a price.

Think this can't possibly happen? In developing countries, who have far less money to spend for health care on their population, patient's who can afford it already hire their own private nurses to take care of them. The unwashed majority are left to fend for themselves with the acute shortage of medical personnel. It is not unusual for a family to go out and get their own medicines and caregivers since they cannot rely on the hospital to do it. And if they can't afford the medicine? Well too bad for the patient.

Will patients and families tolerate all this hands-on inconvenience? People used to think they wouldn't want to fill their own gas tanks either. But as prices rise inexorably higher, the only thing left to cut is the hospital experience. We've already cut doctor's fees, hospital fees, name brand medicine reimbursements, denial of payment for tests deemed "not medically necessary". The medical supplier end is getting cut to the bone. The only fat left to cut is the patient's. Better start comparison shopping .

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