The Importance of Getting Sick in the Right Place

“The Importance of Getting Sick in the Right Place” by Abigail Zuger MD, The New York Times.

It is increasingly critical for patients to be sick in the right place, and increasingly difficult for them to do so. As the great plates of medical care heave and split in cash-based tectonics, the options are multiplying in confusing plenty.

There used to be the doctor’s office and the hospital. Now we have street corner wellness centers and urgent care centers, free-standing emergency rooms with no hospital attached, chain pharmacies with occasional doctors attached, and nursing practices with no doctors attached. We have hospitals that have merged and split and merged again into configurations that put all the cardiologists uptown, all the neurosurgeons downtown, and all the pediatricians somewhere that keeps changing.

We spend a lot of time and energy getting people to where they need to be, launching them according to condition, severity and, always, insurance. Predictable mix-ups occur: Doctors leave insurance plans, patients forget appointments. Or they see the kidney guy, who sends them to a vascular guy, but they already have a vascular guy, and then the cardiologist recommends yet another vascular guy, and now what?

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