Standing in line for your life
Wednesday, July 13, 2005
by Cory Franklin
In the former Soviet Union, long waits and delays for consumer goods and services were a defining feature of communism. There is a joke about a man in Moscow shopping for a car. When he found the one he wanted, he asked when he could pick it up. Checking his calendar, the salesman told him that, because of production delays, he was assigned a pickup day exactly five years from next Friday. Visibly upset, the man replied, "But that's the day the plumber is supposed to come to my house and fix the sink."
The Soviet Union may have crumbled, but delays in services have immigrated to Western health-care delivery systems. The Times of London recently headlined the plight of a young woman told she must wait 80 weeks for a brain scan after being injured in an auto accident. (After the story ran, hospital officials, in damage-control mode, cut her wait to four months with a promise the maximum waiting time would soon be down to a more reasonable 26 weeks.) In Quebec recently, the Canadian Supreme Court permitted a Montreal businessman, forced to wait a year for government-sponsored hip-replacement surgery, to pay for the operation privately.
Not to be outdone here in Chicago, patients in the Cook County health-care system routinely wait months for specialty appointments. In addition, at a recent hearing at Stroger Hospital, patients described waiting days, sometimes weeks, for prescriptions to be filled, then facing lines of several hours when they went to pick them up. (Hospital officials, in damage-control mode, assured everyone they were working to improve the problem. True to their word, the next day they installed chairs outside the pharmacy. The lines were no shorter, but the first 20 patients had the luxury of sitting while they waited.)
If there is any good news, it's that improved diagnostic and therapeutic technologies are the primary factor in the genesis of long waiting times. For generations, the basic medical model was a patient visiting the general practitioner or surgeon, who had a few simple blood tests or X-rays at his or her disposal. Many of those tests could be done right away in the office and, with the exception of an occasional surgical procedure, there was little reason to schedule anything.
Today, the physician's armamentarium includes a wide array of scans, scopes, biopsies, catheterizations, ultrasounds and imaging. Diagnosis is more accurate and surgery less invasive than in the past, but the new procedures are both time and knowledge intensive, requiring ever-increasing levels of scheduling and specialists. Demand sometimes outstrips supply; many people in their 80s and 90s can have surgery today that would have never been contemplated 20 years ago. So when delivery is inefficient for whatever reason, patients face the metaphoric equivalent of a bad afternoon at Disneyland--45 minutes of waiting for two minutes of ride.
The aforementioned long pharmacy lines and delays in specialty care at Stroger are a case in point of inefficient delivery. Services are understaffed but the delays are primarily the result of a system that is overcentralized, i.e., too many people being directed into too few provider points. Imagine the Sears Tower with a single functioning elevator. It doesn't matter how fast it can travel, people will still wait a long time for an elevator.
British statesman Winston Churchill once said, "The inherent vice of capitalism is the unequal sharing of blessings; the inherent virtue of socialism is the equal sharing of miseries." While socialized medical care has made waiting in line a more egalitarian exercise in other countries, in America waiting remains the province of the indigent. If time is money, the conclusion to draw from observing hospitals and clinics is that like everything else that belongs to the poor, their time has less value. In health-care settings, as elsewhere, waiting in line becomes their major charge in life.
Long waits for medical care do more than just harm patients. They rob people of their dignity. Restoring people to good health and maintaining their health is sometimes beyond the control of medicine. But to restore and maintain people's dignity is an essential goal of medical care and remains a valid test of any health-care system. No one should be forced to endure unreasonable waits to see the doctor, get tests or receive medications. One way we as doctors, and as a society, let people know we actually care about them is to make sure they aren't forced to.
Cory Franklin is a physician at Stroger Hospital.