People

An Experiment in Health Care

by Will Nicholson, MD

Wednesday, July 22 was my day off. I slept late and woke up to a voicemail from the department coordinator at my new job asking me to call CNN about an interview: They wanted to know why I dropped my employer’s health insurance benefit.

Two hours later, I was in front of a camera on a live national satellite-feed being questioned about going it alone in the consumer health insurance market.

Three weeks after residency, I was prepared to run a code or manage a shoulder dystocia; I was not prepared for television interviews. Fortunately, similar principles apply. Who knew the skills I learned during my medical training would land me in front of the glare of the national media?

Purchasing health insurance

The night before that interview, an article I wrote had been posted on the internet. It outlined a project I had started: Instead of accepting my employer’s health insurance benefit, I had gone onto the consumer health insurance market as an individual—just as many of my patients have to do—and was finding it challenging.

During residency training, I learned to think objectively about medical challenges. I also learned that addressing the ills of an individual patient often cannot be separated from addressing the ills of the system as a whole. The cardiac arrest, the distressed newborn, the health insurance crisis—I wanted to approach them all with the same medical objectivity and honesty of method.

After three years at a residency clinic, I was painfully aware of the inadequacies of America’s patchwork health insurance system. Every day its complexities and short comings hinder family physicians’ abilities to care for our patients. As we try to provide the same level of care for patients insured by the government, their employer, or a commercial plan, or those without insurance, our patients get sicker faster and die sooner.

I wanted to investigate health insurance without a large grant or research team.I designed the project as a case study, using myself as the case—hopefully one with a good outcome. I planned to start with the proverbial low hanging fruit and learn about the people who are trying to do the right thing but aren’t succeeding. I wanted to become an empowered health care consumer—the essential unit of the individual insurance market—and to see what challenges I met as I made purchasing decisions.

Advocating for family medicine

By the time I left the television studio that afternoon, I had three more requests for national interviews on my voicemail. I was astounded by the level of interest in my little project.

As an advocate for family medicine, I hope the public sees that our profession already holds many of the keys to solving our biggest health care challenges. Our community-based, whole-patient approach has proven to provide the most effective, cost-efficient care available. Unfortunately, I think the public’s trust in many health care experts is eroding; but because family physicians continue to share their daily struggles, trust in family doctors remains.

As a physician who works with patients every day, I don’t think this can be overemphasized. The health care debate has grown so abstract and bizarre and fraught with ulterior motive and political calculation that the best service a physician can offer is to remind people that above all the practice of medicine puts the patient first.

No easy solutions

No one has been more surprised than I by the attention drawn to this project. While it’s too early to make conclusive recommendations, it has been a fascinating experience. In addition to learning about the challenges my patients face, I also better understand the complex value of what we do as a profession. The trust we have built with patients by being there with them in the trenches remains solid even while the health care system frays. It makes me proud to be a family physician.

Although I don’t see any easy solutions on the horizon, I hope my project’s findings are helpful. In addition, I hope the belief of family physicians that effective health care always puts the patient first continues to resonate in clinical practice and public discourse.

Former St. John’s Hospital family medicine resident Will Nicholson, MD, is currently a hospitalist at St. John’s Hospital. Follow his blog at www.triagepolitics.com.