Just about every candidate for president has come out with a health care plan. All of them try to reduce the ranks of the uninsured. Some address rising medical costs, malpractice rates, and other key problems in the health care system.
New Hampshire Public Radio wanted to find out what the health care system looks like for the people those plans are supposed to help.
Over the next six weeks, we present Profiles in Health Care. Through the stories of patients and practitioners, we explore the connections among people from very different walks of life. Today, we begin with a visit to the family practice of Dr. Dick O’Brien in Belmont. Names of patients in this story and some of the details of their illnesses have been changed.
New Hampshire Public Radio’s Doug MacPherson has our report.
TAPE ONE, SFX: NOISY OFFICE 086 – 094
IT’S 8:30 A.M. AT BELMONT FAMILY HEALTH CARE. DOCTOR RICHARD O’BRIEN, A 48-YEAR-OLD FATHER OF EIGHT, SQUINTS UP AT HIS LIST OF APPOINTMENTS.
TAPE ONE, DOCTOR O’BRIEN 117 oh, evan’s coming in huh? Is he sick or is this just a follow-up? NURSE no, just a follow up. :05
FIRST UP THIS MORNING IS CINDY, A 42-YEAR-OLD FACTORY WORKER.
TAPE 3 DOC 233 how are you? [SFX, DOOR CLOSES] :03
CINDY HAS BEEN EXPERIENCING SEVERE PAIN IN HER RIGHT SHOULDER SINCE JULY.
TAPE 3, CINDY 238 At night I can’t pick my arm up, I have to use my other hand, the pain is too much. DOC 255 alright, let’s take a look here. so there’s no injury involved, do you do any kind of repetitive work? CINDY yes // TAPE CINDY 261 my job consists of lifting heavy baskets and pulling a crane across the room. TAPE DOC and how often do you do that? How many repetitions? TAPE CINDY a lot. Maybe 40, 50 baskets a day. :24
O’BRIEN SAYS HE'S SURPRISED THAT MORE NEW HAMPSHIRE EMPLOYERS
DON’T TRY TO SAVE MONEY BY TAKING STEPS TO AVOID PROBLEMS LIKE CINDY’S.
AS O’BRIEN HEADS FOR HIS NEXT PATIENT, OFFICE MANAGER GAIL GLINES SWEEPS BY ON HER WAY TO THE STAFF KITCHEN, BEARING THE LATEST GIFT FROM A DRUG COMPANY SALESMAN.
TAPE 1, GAIL GLINES 020 they brought us bagels with cream cheese for a snack for this morning. And this way they get to meet with the doctor and chat with him for a few minutes between patients.
DOUG so it’s a bribe? GAIL well, it’s pretty close to a bribe. They’re very good to us. :14
TO BE IN FAMILY PRACTICE IS TO BREATH THE PRESENCE OF DRUG COMPANIES. EACH OF THE CLINIC’S SIX EXAMINATION ROOMS HAS ITS OWN CLOCK, EACH BEARING THE NAME OF A DIFFERENT DRUG. EVERY PEN, EVERY PAD OF PAPER, EVERY BOX OF KLEENEX IS DESIGNED TO INSURE THAT THE NEXT TIME A HEALTH CARE PROVIDER NEEDS TO PRESCRIBE, SAY, AN ESCITALOPRAM OXALATE, HE OR SHE WILL THINK “LEXAPRO.”
LATER TODAY, ANOTHER DRUG SALESMAN WILL PROVIDE LUNCH FOR THE PRACTICE’S STAFF OF SIX. IN RETURN, THEY’LL HEAR A TALK ABOUT A DRUG.
TAPE 3, DOC 435 it’s an informative thing for me. I get to learn about a new drug or an old drug with new indications. ///436 and they usually supply thousands of dollars a year in samples that we can give to patients who are needy. :13
THOSE FREE SAMPLES ARE AN INTEGRAL PART OF O’BRIEN’S PRACTICE. HIS NEXT PATIENT IS 10-YEAR-OLD ALEX, WHO SUFFERS FROM SEVERE ALLERGIES. O’BRIEN HAS PRESCRIBED PILLS CALLED “SINGULAIR”, BUT ALEX’S MOM, GINA, SAYS HE HASN’T BEEN GETTING THEM LATELY.
TAPE 5 DOC 407 so the singulair helped with his allergies, but -- can’t afford it. GINA it’s 80 dollars for 30 pills. my insurance just covers the generic, which none of the allergy medicine is generic, and everything’s close to a hundred dollars nowadays. DOC right. :19
ALEX’S FATHER IS A SELF-EMPLOYED TRUCK DRIVER. GINA SHOPS AROUND FOR THE BEST HEALTH PLAN THE FAMILY CAN AFFORD. BUT THE DRUG BENEFITS ARE NEVER VERY GOOD, AND THE DRUGS ARE ALWAYS EXPENSIVE.
TAPE GINA 511 like my asthma. That’s like 80, 90 dollars. And that’s another prescription sitting at home that I should fill. DOC: well, what are you using right now for your asthma? GINA: I haven’t been. DOC: let me give you some samples before you leave today. :15
AS FOR ALEX, O’BRIEN KNOWS GINA’S HEALTH PLAN WOULD LIKELY COVER ONE OF THE ANTIHISTIMINES THAT HAVE BEEN AROUND FOR YEARS. HE ALSO KNOWS THEY’RE LIKELY TO CAUSE ALEX TO FALL ASLEEP AT SCHOOL.
TAPE DOC, 551 so that’s problematic. so for him, I’ll manage him with samples for awhile. And hope they win megabucks. :06
A NURSE INTERRUPTS WITH A CALL FROM A SOCIAL WORKER, PHONING BACK ABOUT ERIK, A 5-YEAR-OLD HOSPITALIZED WITH A HERNIA. THERE’S BEEN TURMOIL IN THE FAMILY; HIS MOTHER SPENT A NIGHT IN JAIL, AND ERIK GOES HOME TOMORROW. O’BRIEN ASKS THE SOCIAL WORKER IF SOMEONE COULD CHECK ON THE FAMILY.
TAPE TWO DOC ONE PHONE 021 does it warrant getting department of social services involved, in terms of evaluating him? I want to make sure whatever turmoil that's going on in the mom’s life doesn’t spill into his life and ruin this kid’s life, you know. :14
WHEN O’BRIEN HANGS UP THE PHONE, IT’S NOT CLEAR IF ANYONE WILL VISIT. THIS KIND OF CALL IS A ROUTINE FACET OF HIS PRACTICE. ON THIS, AN AVERAGE DAY, HE’LL SEE TWO-DOZEN PATIENTS. HE SAYS HE NEVER HAS ENOUGH TIME, BUT HE USUALLY HAS ADEQUATE TIME TO DEVOTE TO PATIENT CARE.
“BELMONT FAMILY HEALTH” FOLLOWS THE INDUSTRY STANDARD OF TWO SUPPORT STAFF FOR EACH PRACTITIONER, INCLUDING ONE TO HELP WITH THE MOUNTAINS OF PAPER WORK THAT COMES WITH HEALTH CARE.
NURSE MICHELLE OETINGER HAS JUST GOTTEN OFF THE PHONE SEEKING PRE-AUTHORIZATION FROM AN INSURANCE COMPANY FOR A M-R-I OF A PATIENT’S BRAIN.
TAPE NURSE MICHELLE OETINGER 013 I was on the phone a good half hour without resolution, and it was a test that was needed ASAP. Then we called them back. I spoke with another person for another 30 minutes. And then finally, they authorized an MRI without contrasts. :16
O’BRIEN ORDERED THE TEST FOR A MAN IN HIS 50’S WHO JUST SUFFERED A STROKE. AN M-R-I WITH CONTRASTS INVOLVES THE USE OF A DYE THAT WOULD REVEAL THE PRESENCE OF A TUMOR. BUT THE COMPANY WON’T PAY FOR THAT.
ONE OF O’BRIEN’S LAST PATIENTS OF THE DAY IS RITA, A 61-YEAR-OLD WOMAN RECENTLY DIAGNOSED WITH DIABETES. RITA’S CASE ILLUSTRATES WHAT’S WORKING WELL WITH MANAGED CARE. O’BRIEN HAS BEEN MONITORING HER BLOOD SUGAR.
TAPE DOC 460 if that continues to drop, then we’ll hold off on any medication for the blood sugars, alright? RITA oh yeah, I hope so. TAPE DOC 461 yeah, I know. well it’s a complex disease. You can add medications to bring blood sugar down. but they also have other side effects. But you’re doing a good job, RITA I’m trying. DOC it’s hard. It requires a major change in your lifestyle. But if you can lose some weight, exercise as much as you can tolerate. TAPE RITA 466 I do, well I go to the wellness center three times a week.
:33
RITA LEARNED A LOT ABOUT DIABETES FROM A COURSE SHE TOOK – WHICH WAS COVERED BY INSURANCE. THE “WELLNESS CENTER” IS A MEDICALLY SUPERVISED HEALTH CLUB HER INSURANCE OFFERS AT A DISCOUNT. O’BRIEN SAYS BOTH ARE PART OF THE RECENT TREND TO TREAT DIABETES MORE PRO-ACTIVELY.
TAPE DOC 525. in the last couple of years, they’ve lowered the diagnostic cut off to be considered diabetic. So by doing that you catch it earlier. You’re treating it earlier, before they manifest any symptoms. :10
IN THE LONG RUN, INSURANCE COMPANIES KNOW THEY’LL SAVE MONEY.
ALL BUT ONE OF THE PATIENTS INTERVIEWED FOR THIS STORY HAD SOME FORM OF INSURANCE. OF THOSE, ALL SAID THEY WERE AT LEAST SATISFIED WITH THEIR COVERAGE. BUT NOT EVERY PATIENT ARRIVES AT O’BRIEN’S OFFICE WITH A VALID INSURANCE CARD.
TAPE 5, DOC 105 when my patients are between jobs and they lose their insurance, but they still need to be seen for an acute visit or for a recheck of their blood pressure or fill medication, I don’t -- we don’t -- refuse to see them. We either work out a payment schedule or you just write it off. :17
THE FREE CARE DOES NOT WEIGH HEAVILY ON HIS BOTTOM LINE. WHAT DOES HIT HARD IS MEDICARE. CLOSE TO HALF OF O’BRIEN’S PATIENTS ARE ON THE GOVERNMENT PROGRAM. HE SAYS IT DOESN’T COVER THE COST OF TREATMENT. IF HE HAD MANY MORE MEDICARE PATIENTS, O’BRIEN SAYS HE’D LOSE HIS SHIRT.
O’BRIEN SAYS FOR THE MOST PART, HE ENJOYS HIS PRACTICE. HE
HATES THE TWO HOURS OF PAPERWORK THAT OFTEN FOLLOW A 10-HOUR DAY.
AND HE’S CONCERNED ABOUT UN-INSURED AND UNDERINSURED PATIENTS. BUT FOR ALL THE TALK OF SOLUTIONS FROM POLITICIANS, O’BRIEN HAS LOW EXPECTATIONS. IN FACT, HE’S MORE WORRIED ABOUT THE POTENTIAL CURE THAN THE DISEASE.
TAPE 5, DOC 211 what I’d fear most would be an inflexible, behemoth of a bureaucracy created by the government. :06
FROM WHERE O’BRIEN SITS, THE HEALTH CARE SYSTEM COULD USE SOME INCREMENTAL CHANGE, BUT HE DOESN’T SEE A NEED FOR RADICAL REFORM. O’BRIEN SAYS GOOD HEALTH CARE IS A COMMUNITY-WIDE CONCERN. AND HE BELIEVES IN BELMONT, THE COMMUNITY IS DOING A GOOD JOB OF PROVIDING GOOD CARE.
FOR N-H-P-R NEWS, I’M DOUG MACPHERSON.
