When John Battelle’s teenage son broke his leg at a suburban soccer game, naturally the first call his parents made was to 911. The second was to Dr. Jordan Shlain, the concierge doctor here who treats Mr. Battelle and his family.
“They’re taking him to a local hospital,” Mr. Battelle’s wife, Michelle, told Dr. Shlain as the boy rode in an ambulance to a nearby emergency room in Marin County. “No, they’re not,” Dr. Shlain instructed them. “You don’t want that leg set by an E.R. doc at a local medical center. You want it set by the head of orthopedics at a hospital in the city.”
Within minutes, the ambulance was on the Golden Gate Bridge, bound for California Pacific Medical Center, one of San Francisco’s top hospitals. Dr. Shlain was there to meet them when they arrived, and the boy was seen almost immediately by an orthopedist with decades of experience.
For Mr. Battelle, a veteran media entrepreneur, the experience convinced him that the annual fee he pays to have Dr. Shlain on call is worth it, despite his guilt over what he admits is very special treatment.
“I feel badly that I have the means to jump the line,” he said. “But when you have kids, you jump the line. You just do. If you have the money, would you not spend it for that?”
Increasingly, it is a question being asked in hospitals and doctor’s offices, especially in wealthier enclaves in places like Los Angeles, Seattle, San Francisco and New York. And just as a virtual velvet rope has risen between the wealthiest Americans and everyone else on airplanes, cruise ships and amusement parks, widening inequality is also transforming how health care is delivered.
I started and stopped writing this post many times because it’s mostly whining. But, dammit, it’s a consumer’s right to whine, so here it is: in my experience (YMMV) — and that of many others I know — the health care system largely treats patients like garbage.
I was reminded of this fact during my recent experience dealing with my daughter’s broken arm. It started well enough. Our pediatrician has late hours and an X-ray machine, so we were able to skip the Friday night (and more expensive) emergency department visit for our initial diagnosis, and therefore missed all the attendant waiting and frustration.
Upon viewing the X-rays, the pediatrician conveyed that it was not a bad break and didn’t need to be addressed immediately. A brace, which she provided, was good enough for now. Fair enough. But what was our next step? “The X-rays need to be examined by a radiologist before I can tell you that,” my wife was told. OK …
I wonder how long we would have waited for that to happen. By the middle of Saturday, we became too uncomfortable to find out, so I called the pediatrician’s office. Now, and with no further consideration of the X-rays, they were wiling to give us some recommendations for orthopedic clinics. Why couldn’t those have been given to us on Friday?
Naturally, one clinic was closed on the weekend. But, the other, hospital-based one, had Sunday hours. Great! A call to that clinic got me a voice-mail. I left a message. I have never gotten a call back, but I didn’t wait for one. I called again later and got a person who told me they had 7AM walk-in hours. Just go to the main hospital entrance and ask for the walk-in orthopedic clinic, I was told.
This was bad advice. After dragging my broken-limbed daughter through every door that plausibly seemed like the main entrance, we finally found someone who said we should go through the ED entrance. That was the right answer, but not what we were told on the phone.
After waiting and registering, we finally saw the orthopedist. He was great. It was, in fact, not a bad break. Now it is safely casted. All is well. But not before we had to do a lot of legwork — and received a lot of wrong answers, promises of follow-ups that didn’t happen, etc. Meanwhile, our pediatrician has not (yet) checked in on her patient.
I get it. She’s busy with more urgent matters. It makes sense, but it sucks, and all the more knowing that we spend a fortune for such treatment. No other business would treat customers this way. In health care, inconvenience, uncertainty, lost records, lack of follow-up and coordination, the necessity of self-advocacy, and lots and lots of waiting is the norm.
Of course, there are some examples of good customer service in health care. I’ve even experienced them. But every tasty crumb I’m tossed just reminds me how awful the rest of the meal is.
2017 will be a transition year shaped by changes proposed by President-elect Donald Trump and a Republican Congress. Chief healthcare concerns include legislative proposals to “repeal and replace” the Affordable Care Act (ACA), along with the continued movement to implement alternative payment models (APMs) as called for in the Medicare Access and CHIP Reauthorization Act (MACRA). We will address the potential changes ahead when it comes to shifting health benefits, provider supply, new care models, transparency, and the continued growth of consumerism. 2017 will be a dynamic year as we pivot and move in a new political direction.