a special program of the National Emergency Medicine Association (NEMA)

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 Transcripts: 545.1 to 545.3

Week: 545.1 Guest: Dr. C. Everrett Koop, Former U.S. Surgeon General Topic: The Changing Face of Health Care, Part One of Three Producer/Host: Steve Girard

NEMA: The U.S. health care system is in flux...and while you hear a lot about traditional health insurance coverage versus Health Management Organizations, it's not only how we pay for medical service, but how the entire system is structured and administered. And it's become a game of "who do you trust" to find someone who can help you through health problems. We have the pleasure to talk with former U.S. Surgeon General C. Everett Koop today...doctor, how do you see the changes in the health care system over the last several years.

KOOP: What's happened in this country over the past five years, but especially over the last two is that we've shifted from the old, time-honored system of a fee-for-service medicine...where you saw the doctor, and you paid for what you got, and you had as many tests and consultations as he thought were appropriate for you to have...to assist in what is called managed care, where a system works primarily through a gate-keeper', who is a primary care physician, who decides what your diagnosis is and then, if need be...limits the amount of testing, consultation, and referral that you can have. The result is that the premiums for health care have come down, but with it, the dissatisfaction on the part of patients and the frustration on the part of patients has gone up. I think that the public has to look at this era right now as a transition between what we did have and what we will have...and I think that over the next several years, there will be a working out of some of the conflicts that people have. What has happened is that state legislatures have taken things to heart, and 17 of them, in the past year, have passed some kind of legislation or regulation that assures patients that they will not be denied care when it is appropriate and also, opens up some of the contracts that patients have with managed care companies, so that the patient understands whether or not the doctor himself profits by not doing the kinds of things the patient thinks ought to be done. So, it's a transitional period , and it's very difficult for an individual to make a decision because most of insurance is purchased by employers. But once you're in it, it doesn't mean that all is lost. There are things you can do even when you don't like the system

NEMA: People have to be proactive in finding ways they can use the system effectively....

KOOP: You have to take more charge of your health, and that means you have to be informed...and this is a good era to do it, because there's a whole new generation of people now who are devoting themselves to patient information and education, just so patients do feel more secure about that. But, you really don't have as much choice of doctors under this system as you had under the old one, because when you go to a managed care company, your doctor may not be part of that managed care company, and therefore, you've lost him....and then, you're not always sure that you can choose one you want out of that group, or that you'll see this same one every time that you go back. This is one of the frustrations that I mentioned that patients complain about.

NEMA: Dr. Koop says that the key to feeling more comfortable in the health care system is, as it always has been, finding a doctor you feel comfortable with...the one on one relationship that remains the heart and soul of medicine. We'll return with Dr. Koop next time to talk about the evolution of health care on our next program. Thanks for joining us, I'm Steve Girard.


Week: 545.2 Guest: Dr. C. Everrett Koop, Former U.S. Surgeon General Topic: The Changing Face of Health Care, Part Two of Three Producer/Host: Steve Girard

NEMA: Former U.S. Surgeon General C. Everett Koop joins us again to talk about the changing face of health care. We did a story recently on St. Agnes Hospital in Baltimore, which led the charge, so to speak, in forcing everyone to recognize a new mother needs at least two days in the hospital after the birth of her child...it opened my eyes to the kinds of pressures doctors, administrators, and patients may feel under managed care and insurance industry mandates.

KOOP: That whole thing is a perfect example of what's happening, and it will happen with one little thing at a time...and it went from disturbed patients and doctors, to protests, to having local regulations, and now there's a national law that says a mother has to have 48 hours in the hospital if the physician deems that's what she should have.

NEMA: A person trying to sort out the health care system has to, these days, realize it's a corporate structure, sometimes hard to get comfortable, and get results...

KOOP: But you know, once you get into it and you don't like what your doing, my advice is to get hold of a social worker or a caseworker, and say, "I know that I am not getting what my doctor would really like to give me because the rules of this organization say that he's not to do that now. " And you can usually find a champion who will fight your cause for you.

NEMA: You mention you think we're in a transition period, but what do you see us headed for? Is it getting better?

KOOP: Well, it's getting better if you look at the 17 states that have done something in the past year to ensure better relationships between doctors and patients. California is having two propositions on their referendum this year that address this issue, but just last week, Governor Wilson signed a state law that maybe makes those two protests by ballot unnecessary because they do lay out protections for patient and physician, to see that patients get all that they should have. So, things are moving in that direction, but there are going to be some bumps on the road, but I think you'll hear fewer horror stories, and things will get better over the next couple of years.

NEMA: It seems at the core of the health care system, the essence of it should remain the one-on-one relationship between patient and doctor...as you said, the gatekeeper for all medical services....

KOOP: Well, there are a lot of people out on the stump, such as I, who are really reminding the public about the doctor-patient relationship, and that it is the very heart and soul of medicine. And that's the thing we have to maintain, or the whole thing goes down the drain.

NEMA: People are facing a more complicated health care system, and there are problems, bugs and frustrations that come along with the package of change, but realize that we have better techniques and practices today than ever before, and in many ways, more choices and services too. So while the good old days may have been good, today they're just old...and we'll all adapt to the new. Our thanks to Dr. C. Everett Koop, former U.S. Surgeon General. He'll be with us again soon to talk about what it's like to be a doctor in the system today...being an advocate for the patient, and trying to pair that role with one of businessman and corporate employee. I'm Steve Girard.


Week: 545.3 Guest: Dr. C. Everrett Koop, Former U.S. Surgeon General Topic: The Changing Face of Health Care, Today's Doctors, Part Three of Three Producer/Host: Steve Girard

NEMA: We've been talking with former U.S. Surgeon General C. Everett Koop about the changing face of health care. We've talked about people getting the most out of managed care by being proactive...getting the best information on their health plan, playing a strong role in deciding what treatments and procedures may be needed... and it all begins with finding a doctor you're comfortable with to be your gatekeeper' to all these services. There are many pressures on doctors today, Dr. Koop....what is it like to be one these days? What does the phrase "good doctor" mean now?

KOOP: I still do consultations on the telephone for all kinds of people, and I think that you could summarize it this way...That a doctor goes to an educational system, where he spends a third of his life learning to be an advocate for his patient. And, as long as he can do that, he doesn't feel frustrated and he thinks he's satisfying what he went into medicine for...which is to save lives and alleviate suffering. But if the system, the corporate structure that employs him, puts constraints on his activity to be a patient advocate, then the patient gets a poorer quality of care, and the doctor has the frustration and guilt that he's not doing what he set out to do in life. And that's where the whole crux comes, and that's what the argument's about.

NEMA: Are today's doctors and their successors destined to be locked into this kind of system...or will these changes help the system to bloom and work smoothly in the years ahead?

KOOP: I think they are going to be locked into a system that was much different than that which their fathers practiced...but, you know, it's ...what's interesting is that the current system is complained a lot more by people who are 60 years old...in medicine....than it is in people 40 years old, but it's accepted as the norm by people who are just entering the practice of medicine..say age 28 to 30. So, what I look at with some horror today, these young men, when they're my age, will look back to as, "the good old days". And that's how medicine evolves, and it's always rough during the evolutionary stages, but it straightens out, and then it becomes the norm, people accept it, then it improves gradually, and then something else happens to change it again.

NEMA: Even a business as large and important as health care does have to adjust to the societal bends in the river...like the way the industry had to take notice when hospitals like St. Agnes in Baltimore forced the issue of post natal stays and the public backed them up. I get the feeling that people will continue to be their own watchdogs where health care is concerned...keeping an eye on the societal changes and to influence where it goes in how it concerns them and how they're taken care of....

KOOP: Well, it does...and in just the way you mentioned a moment ago about the pressure for keeping mothers in the hospital for two days...it starts out by fiat, and then it gets backed up and smoothed out, and pretty soon you have a system that works again. But that's how we go.

NEMA: Many thanks to our guest, Dr. C. Everett Koop, former U.S. Surgeon General. The health care system is changing...perhaps it always has..and will...but as we heard from Dr. Koop, through all these structural changes, we have to keep the focus on the relationship between doctor and patient...the advocate and the person who needs help. And don't get frustrated, get informed, and get proactive about your health. I'm Steve Girard

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