Medical debt for doctors and patients hurting healthcare

Editor’s Note: This week, at the Democratic National Convention, Vinod Seth, MD, an internist and infectious disease physician will share his thoughts on being both a doctor and a delegate for the Democratic Party. Seth practices in Bismarck, North Dakota.
 

Dr. SethOn June 24, 1971, I landed in Chicago for my internship. I had graduated from medical school in India in 1970 and $175 was all that four-and-a-half years of medical education cost me.

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Forty-five years later, I am excited to be at the Democratic National Convention with my wife, also a delegate.

For us, democracy has never been a spectator sport.

In 2002, my wife won as a write-in candidate to the local public school district board. It was a joy when, as president, she gave our kids their high school diplomas. It was a fun campaign to run. I was hooked.

Related: Obamacare receives a big, fat 'F' from physicians

My last day of full-time work was last November in Scranton, Pennsylvania, as an infectious disease physician. The template driven electronic health record (EHR) notes-padded-to-enhance-billable-dollars; the 10-point review of systems at the touch of a button; the all-employed nature of clinical practice with, paraphrasing Dr. Seuss from the Lorax, “…no one to speak for the trees;” these changes bothered me. The extra bills to patients was wrong.  I left Pennsylvania to return to North Dakota.

Soon Bernie Sanders’ candidacy picked up momentum. We were overseas. I was especially taken by his push for “Medicare for All.”

Pancake breakfasts and spaghetti suppers organized by families seeking help for medical bills of their loved ones have upset me for years. Medicare for all was needed. Bernie was the right candidate to support. “Obamacare” never went far enough. With lobbyists blocking it, a public option on exchanges did not happen. Too many are still not covered. There are too many loopholes and gaps in private plans. Only the truly ill and their families learn of these. Over 640,000 people go bankrupt annually for unpaid medical bills.

Next: Seeing struggles of our patients

Working with mostly 20- to -45-year-olds-most first time voters-we won North Dakota for Bernie. In our home, 1,000 cups of chai tea must have been served, as these young men and women stopped by to work their hearts out. They trusted Bernie’s vision of America. We should too.

College debt concerned these young Berners. The ginormous college debt of our young doctors is a negative for society. I believe the debt-burdened physician is more likely to push for early hospital discharge at the dictates of hospital administration, be more easily tempted to pad his EHR notes, order more tests, more procedures and more surgeries.  A fee-for-service system, where more is better for doctors’ wallets is tempting. Debt makes that real.

Bernie’s stress on income inequality is good for doctors and patients alike. Reaganomics’ “trickle down” vision never worked. Only one thing trickles down, and that word begins with “P.” Money does not. It floats up. With Bernie’s $15/hour minimum wage plan, more money is given to the bottom 50% of America and all will be spent stimulating the economy, finally lifting all boats.

More from the DNC: Delegate physician says affordable healthcare vital for rural America

As a doctor, we only see some of the struggles of our patients and their families; the juggling of time and scarce family resources is hidden from us. As an infectious disease physician, I find an “fever of unknown origin” a stimulating diagnostic challenge. From our patients’ perspectives, it is an economic disaster. The story of a recent patient, a second opinion, on my last locums assignment is illustrative.

This 50-year-old patient with an undiagnosed fever of three weeks seemed woried. He shared as I sat talking to him that he had just been laid off from his job of 20 years. He had used up his sick days. His company was sorry. All reassurances that he would be rehired when he recovered rang hollow. He was worried that his wife would not be able to take more time off, and also lose her job.

Being sick is enough. Economic fears hurt our patients and us. It has been hard to hear many such stories over the years.

Next: Join Bernie in his fight for working class America

I believe that our sick patients need us to join Bernie in his fight for working class America. His vision including Medicare for all will be good for all.

We all do better, when we all do better.

Further reading: Doctors among those protesting Trump at GOP convention

That is why I am here in Philadelphia at the DNC for this ritual of our beautiful democracy.

I will be on Periscope @askdoctorvinod from inside the DNC.

Join me.