By Dr. Mahomed Rayhaan Dawood
When you practice medicine for a while, you start to realize the real world isn’t anything like what you learned in medical school or in its textbooks. We are taught to ask the right questions, and to outline treatment options; medication, surgery, and recovery, that best fit the patient and their medical troubles. However, when you finally get to stand in front of a patient who’s relying on you for relief, you realize the grim limitations of real world medicine that shrink and inhibit the examination room. As a doctor, you come to realize that the hands that are trained to heal…are tied. There are major barriers that doctors and patients face that prevent doctors from providing treatment, and patients from receiving the best treatment to heal. A doctor can ask all the right questions, do a thorough examination, and prescribe the best medications, but when a patient can’t afford the prescription medication or the physiotherapy appointment, then as a doctor, I am frustrated that I stand almost helpless to take away the pains and sufferings of others, and my hands are tied by the need of cold-hearted cash. Limited financial resources, in my opinion, are one of the biggest determinants of poor health.
It is absolutely disheartening and demoralizing to know that there is a solution, but I am unable to get the care the patient needs, for the sheer reason of finance. I remember a friendly elderly lady with end-stage cancer and chronic pain who couldn’t afford the physiotherapy visits that could help bring some relief. The middle-aged mother who stopped her insulin because she lost her insurance coverage and could not afford the outrageous out of pocket costs. Or how about the immigrant factory worker who didn’t have time to actually go to his medical appointments because working 14-hour shifts to pay for his children’s education took priority over his own health. Countless physicians encounter scenarios like this on a daily basis, and this, for me, wrenches my heart that I am helpless to help a patient in need of some relief.
The common theme, no matter how you distill it, is lack of access to wealth. The poorer the patients are, the worse their health will be, and based on my own experience, this issue seems to be worsening year after year. As physicians, we are trained to be healers, but with the biggest roadblock between physicians, patients, and better health solutions being money, this ambition seems like just another pipe dream sold to tens of thousands of students whose goal is to heal their community. Unfortunately, we have been watching this issue grow worse with the ongoing COVID-19 pandemic; from patients who receive top of the line Covid-19 treatment, and dictate how, when, where, and by whom they receive this behind-the-golden-door care, to those who stand in line for hours in the cold, skipping work, just to get tested. Money and wealth typically lead to better health, and we continue to see this gap widening into a chasm between the haves and the have nots.
These healthcare inequities have been around and been known from the start of healthcare. Only recently, has the awareness grown to demand change. But, how do we fix it? We can’t just write “money” on a prescription pad. Solution so simple as to identify and expand healthcare access in ways that have been neglected in the past has proven to be a bridge too far. We can, however, start by focusing on increasing access to drugs through national pharmacare programs, mandating that a select panel of drugs (antibiotics, insulin, and other basic medications) be covered no matter what, (some medications have become over the counter (OTC), and have skyrocketed its prices). This will ensure all people fair access to life-saving and general medications without the burden of cost and affordability. Perhaps we can take some lessons from other countries where they set limits to the costs of specific medications.
Some suggestions I would like to offer is: to set in place strict mandates for basic coverage, such as physical therapies and rehabilitative treatments for before and after surgeries, and for other muscular and soft tissue conditions, and require insurance coverage for these treatments with no questions asked. Mental health programs like counseling and therapy should be free (covered by insurance and/or government) or combine it with an adjusted sliding scale of cost based on yearly income to allow fair access to these programs. Hospital networks must bear the responsibility to offer psychiatric services or be penalized with fines and budgetary limitations.
With the Covid-19 pandemic, timing is perfect to partner up with technology companies to better develop and expand the telehealth platform. A better telehealth service, when done correctly, could exponentially increase accessibility to healthcare for hundreds of thousands of people at the ready.
At the end of the day, we have to ask ourselves, “What kind of world do we want to live in?” One where only a few have access to good healthcare, while the rest of the less fortunate suffer. Or one where no one has to fear that they will be able to afford life-saving medications, treatments, and therapies. The healthcare system will never truly be “fair,” but we must absolutely work harder to level the healing field for all. No doubt, this will cost money, but there are other areas of healthcare where money can be saved. Administrative costs and the exorbitant amounts of money funneled to insurance companies and the pharmaceutical industries would be a good place to start. There is no easy fix; there is no simple process to right the wrongs of a healthcare system that has been poorly implemented over many decades, but by focusing on the end goal, we can take the first steps to implement the right changes.
Undoubtedly, some would view such programs or measures as idealistic, but I will end with the following thoughts to ponder. The tenets of a productive society go hand in hand with good healthcare. A healthy population will be a productive one that ultimately will lead to a wealthy population.
[All views expressed in this article belong to the author and are not representative of the views of New American Healthcare or any of its team members.]
Mahomed Rayhaan Dawood earned his Medical Degree from the College of Human Medicine at Michigan State University and is currently a practicing family physician in Canada and an Assistant Clinical Professor at McMaster University. He runs and operates a full-time Family Medicine Practice; Aesthetic Medicine and Anti Aging Clinic; and International Travel Medicine Clinic. His interests beyond clinical medicine include Public Health and Healthcare Technologies, and Cryptocurrency and Blockchain Technologies.