Health Care and the Chronically Ill; H. Hodson

With each illness progression, our doctors face the fact that their previous treatment is no longer working. They then truly practice the art of medicine-searching for the comMs. Hodson resides in New York City. bination of medications which will save their patient's life. After the crisis passes, they must then find a way to help us adapt, not only to the damage done during the latest episode, but also to the side-effects of the drugs we now need. Our physicians are at the forefront of medical research, with each treatment a double-edged sword, requiring them to constantly balance its risklbenefit ratio. So, what is my experience at HMOs and why am I so terrified that my fellow lupus patients and others with chronic ailments will be forced into them? First, I have repeatedly found that HMO physicians and allied health providers lack a basic knowledge of lupus and other complex disorders. They often fail to diagnose these diseases, and when they do make the diag nosis, they fail to institute appropriate treat ment. They routinely refuse to give referrals to specialists, because in their ignorance they deem it unnecessary. In addition, they misprescribe drugs, seemingly unaware of the vast array of dangerous medications their patients use.

Secondly, the ten minutes HMOs allow for appointments is insufficient for almost anyone, but especially the seriously ill. In this hasty encounter, the doctor must do his review of patient history, ask any questions, conduct his examination, make his decision for appropriate treatment, and explain it all to the patient. With an incurable illness, this 588 HEALTH CARE AND THE CHRONICALLY ILL 589 cannot be done. Yet I have been told by HMO doctors that ten minutes is all the time they are allowed-regardless of medical need. Lastly, there is uniformly a lack of con tinuity and consistency in care. I enlisted in an HMO eight years ago. During this period, I have never seen the same physician twice. In dermatology alone, I've had eight differ ent doctors. I gave up any hope of ever receiving competent medical attention at this HMO last July. I called saying I had a rash on my face and was developing a bald spot on my head-symptoms indicating lu pus activity and the need to see a dermatol ogist. With full knowledge that I have lupus, but lacking the ability to care for a lupus patient, I was given the first available appointment, three months in the future. I called my private-practice dermatologist who has cared for me for 23 years. He saw me that day, gave me a steroid shot and free samples of the prescriptions I needed.

Since my diagnosis, my team of private practice physicians have responded daily to my many medical needs. Never have I had to wait for an appointment. Never have they failed to institute appropriate treatment. It is only because of this kind of dedicated care by my team of independent physicians that I am alive today. Had I been restricted to HMO care, I would not have survived. If medical care for the low and moderate income chronically illis restricted to HMOs, I fear for my life and for the lives of those I counsel and care for. D THEFREEMAN IDEASON UBER1V Socialized Health-Care Nightmare by Yuri Maltsev and Louise Omdahl I n 1918,the Soviet Union's universal "cra dle-to-grave" health-care coverage, to be accomplished through the complete social ization of medicine, was introduced by the Communist government of Vladimir Lenin. "Right to health" was introduced as one of the "constitutional rights" of Soviet citi zens. Other socioeconomic "rights" on the "mass-enticing" socialist menu included the right to vacation, free dental care, hous ing, and a clean and safe environment. As in other fields, the provision of health care was planned and delivered through a special ministry. The Ministry of Health, through its regional Directorates of Health, would pool and distribute centrally provided re sources for delivery of medical and sanitary services to the entire population.