A shave, a haircut and a blood pressure check.
May 23, 2018 9:32 PM Subscribe
Barbers can do a better job of delivering healthcare than doctors. "We have the health care system [in the U.S.] we do because of history and economics, not because of studies that show it’s optimally designed. Changes are most often made within the current framework; those that buck the system are usually met with more resistance."
For context, my organization is going through an economic “crisis” brought on by insurance company shenanigans and the response has been to make doctors cut more corners to see more patients, which pays more. Meanwhile, the medical errors and near-misses are piling up and there’s zero economic consequence for delivering bad care.
Last week, one of my colleagues pointed out that there are now more administrators in our organization than providers (who are the only people capable of generating revenue). So that means my work has to pay the rent AND the salaries of my medical assistant, my registered nurse, and 1.1 middle managers whose primary job is telling me to work harder.
I was accepted to grad school for health administration for next year. I don’t even care about making more money or becoming a medical director. I just want to burn the whole system down so I can practice medicine again.
posted by Slarty Bartfast at 10:11 PM on May 23, 2018 [34 favorites]
Last week, one of my colleagues pointed out that there are now more administrators in our organization than providers (who are the only people capable of generating revenue). So that means my work has to pay the rent AND the salaries of my medical assistant, my registered nurse, and 1.1 middle managers whose primary job is telling me to work harder.
I was accepted to grad school for health administration for next year. I don’t even care about making more money or becoming a medical director. I just want to burn the whole system down so I can practice medicine again.
posted by Slarty Bartfast at 10:11 PM on May 23, 2018 [34 favorites]
Tbh, I'm increasingly weirded out by the propensity to crap on physicians for systemic problems in health care policy and administration. Not that they don't play a role, but the whole structure is garbage. Health care improves when we value convenience, access, and generally being less kafkaesque.
If you read the journal article (thank you, sci-hub), it makes it more clear that the pharmacists saved the day.
posted by cichlid ceilidh at 10:33 PM on May 23, 2018 [9 favorites]
If you read the journal article (thank you, sci-hub), it makes it more clear that the pharmacists saved the day.
In conclusion, medication management that was delivered in barbershops by specialty-trained pharmacists, as compared with standard management afforded by primary care practices, resulted in much larger blood-pressure reductions in black male patrons of those shops who had hypertension.The earlier (limited) study referred to in Times piece found that people referred to PCPs were under-treated for high BP as compared to those referred to……hypertension specialists.
posted by cichlid ceilidh at 10:33 PM on May 23, 2018 [9 favorites]
I am just disappointed to find that leeches are no longer involved.
(Literal ones, I mean, that's not a metaphorical reference to unnecessary administrative figures who may have worked their way into the system..)
posted by Nerd of the North at 10:46 PM on May 23, 2018 [4 favorites]
(Literal ones, I mean, that's not a metaphorical reference to unnecessary administrative figures who may have worked their way into the system..)
posted by Nerd of the North at 10:46 PM on May 23, 2018 [4 favorites]
See also: cancer screening and supporting victims of domestic violence.
posted by camyram at 11:29 PM on May 23, 2018 [3 favorites]
posted by camyram at 11:29 PM on May 23, 2018 [3 favorites]
(Ten bucks says they can't replicate in a functional healthcare system)
posted by Merus at 12:33 AM on May 24, 2018 [1 favorite]
posted by Merus at 12:33 AM on May 24, 2018 [1 favorite]
As a social worker in healthcare I have so much to say. This is my soapbox.
There are absurd pressures about delivering healthcare and what happens and when it can happen and reimbursement is a huge factor.
And Social Issues are not billable in a meaningful way. I'm an LCSW, and cannot bill for my service unless it is directly related to an assessment for hospital psychiatric admission.
So, no one wants to pay me to solve the problem of transportation, or the at home blood pressure cuff for the impoverished. Or finding who will see their patient on a Saturday morning when they aren't working. No one will pay me for the emotional investment or support, education on lifestyle changes, or how mental illness and health conditions impact each other. No one will pay me to teach an adult on food stamps how to access a low sodium diet. No one will pay me to comfort a child after a car accident, or teach a gunshot victim about signs of PTSD. These aren't easy issues. And there are so so many.
What pays is me getting the person out so that someone else can have an appointment or bed.
We know there are great interventions to help individuals with significant health care barriers access/utilize care. There is also much to be said about screening and treatment of mild to moderate mental health issues. There is even more to be said about the quality of care when you have someone where accessing care is an issue, all visits need to be comphresensive as possible.
And there is the other stuff that involves significant social work time (or should), child and elder abuse assessments (the non medical part anyway), transitioning to long term care, arranging intensive medical services, and the economic and mental health stress that comes with a sudden accident or illness. Especially when people lose their jobs over one missed day.
So with all that said and all that potential for care and change, the thing I do the most is assisting with transportation AWAY from the facility. Transportation to the qualifications are more stringent than leaving...and this has to do soley with if that person is gone, someone else can be treated.
It's also hard to figure out what I should focus on, when my caseload is great and needs are high, I can't see everyone. Only the most pressing needs even get a consult. There are so many times I want to be able to walk someone through a problem that could really change the outcome of their care (like helping someone fill out a paratransit application which is a ride service for disabled adults) and the most all I can do is give them the phone number. AND that is IF (a very big IF) the doctor deems the social issue worthy of a social work consult. That takes time, and means there is no billing happening.
Obviously (to me), billing for these issues is problematic at best, because patients can't pay. But the answer isn't to ignore the issues and send them on their way, and that's if they ever access care at all.
posted by AlexiaSky at 2:10 AM on May 24, 2018 [16 favorites]
There are absurd pressures about delivering healthcare and what happens and when it can happen and reimbursement is a huge factor.
And Social Issues are not billable in a meaningful way. I'm an LCSW, and cannot bill for my service unless it is directly related to an assessment for hospital psychiatric admission.
So, no one wants to pay me to solve the problem of transportation, or the at home blood pressure cuff for the impoverished. Or finding who will see their patient on a Saturday morning when they aren't working. No one will pay me for the emotional investment or support, education on lifestyle changes, or how mental illness and health conditions impact each other. No one will pay me to teach an adult on food stamps how to access a low sodium diet. No one will pay me to comfort a child after a car accident, or teach a gunshot victim about signs of PTSD. These aren't easy issues. And there are so so many.
What pays is me getting the person out so that someone else can have an appointment or bed.
We know there are great interventions to help individuals with significant health care barriers access/utilize care. There is also much to be said about screening and treatment of mild to moderate mental health issues. There is even more to be said about the quality of care when you have someone where accessing care is an issue, all visits need to be comphresensive as possible.
And there is the other stuff that involves significant social work time (or should), child and elder abuse assessments (the non medical part anyway), transitioning to long term care, arranging intensive medical services, and the economic and mental health stress that comes with a sudden accident or illness. Especially when people lose their jobs over one missed day.
So with all that said and all that potential for care and change, the thing I do the most is assisting with transportation AWAY from the facility. Transportation to the qualifications are more stringent than leaving...and this has to do soley with if that person is gone, someone else can be treated.
It's also hard to figure out what I should focus on, when my caseload is great and needs are high, I can't see everyone. Only the most pressing needs even get a consult. There are so many times I want to be able to walk someone through a problem that could really change the outcome of their care (like helping someone fill out a paratransit application which is a ride service for disabled adults) and the most all I can do is give them the phone number. AND that is IF (a very big IF) the doctor deems the social issue worthy of a social work consult. That takes time, and means there is no billing happening.
Obviously (to me), billing for these issues is problematic at best, because patients can't pay. But the answer isn't to ignore the issues and send them on their way, and that's if they ever access care at all.
posted by AlexiaSky at 2:10 AM on May 24, 2018 [16 favorites]
What a cool study. Rather than being an opportunity to criticize doctors, I think it really shows the value of incorporating health into every day life and weaving care more deeply into communities. This changes the social and physical environment, and that can have a huge effect on health.
posted by entropone at 4:26 AM on May 24, 2018 [4 favorites]
posted by entropone at 4:26 AM on May 24, 2018 [4 favorites]
If my colleagues in veterinary medicine offered the level of service and care that the US healthcare system offers, they would be out of business within months.
Let's just say I have heard many cases of veterinary professionals who run blood tests, stitch up lacerations, and take x-rays for their friends and co-workers. It sucks, because there are very good reasons why those things should be done by human medical professionals, but not getting them done because of bullshit insurance reasons sucks worse.
I just want to burn the whole system down so I can practice medicine again.
I'm actually really glad to hear you say that, Slarty Bartfast. I've thought for a while that reforms are not going to be enough to fix our healthcare system, but I've rarely heard physicians taking that same stance. You have my axe &c.
posted by Rock Steady at 5:10 AM on May 24, 2018 [3 favorites]
Let's just say I have heard many cases of veterinary professionals who run blood tests, stitch up lacerations, and take x-rays for their friends and co-workers. It sucks, because there are very good reasons why those things should be done by human medical professionals, but not getting them done because of bullshit insurance reasons sucks worse.
I just want to burn the whole system down so I can practice medicine again.
I'm actually really glad to hear you say that, Slarty Bartfast. I've thought for a while that reforms are not going to be enough to fix our healthcare system, but I've rarely heard physicians taking that same stance. You have my axe &c.
posted by Rock Steady at 5:10 AM on May 24, 2018 [3 favorites]
Slarty Bartfast: No disrespect to barbers. I have a closer relationship to mine than I do to my PCP.
Because you probably see your barber more often, and under much less stressful circumstances, than your PCP. And your PCP probably costs you more than your barber, and there's the chance that your insurance will screw you over when you visit your PCP, so stress upon stress. My mother-in-law tests her blood pressure at home specifically because her blood pressure goes up when she's at the doc's office.
Or the doctor's offices can install those lovely hair washing stations -- nothing is more soothing (to me, at least) than a scalp massage with hot water. Then take the patient's blood pressure, and after that, tell them how much their medical bill will be.
And no mention of bloodletting so far, or in the article? Per Wikipedia: The red and white pole outside barber shops references a time when barbers were expected to perform bloodletting and other medical procedures to heal the sick; red may have represented blood and white may have been bandages. [Citation needed, because really, I'm gonna need to see a cite for that.]
posted by filthy light thief at 7:52 AM on May 24, 2018 [3 favorites]
Because you probably see your barber more often, and under much less stressful circumstances, than your PCP. And your PCP probably costs you more than your barber, and there's the chance that your insurance will screw you over when you visit your PCP, so stress upon stress. My mother-in-law tests her blood pressure at home specifically because her blood pressure goes up when she's at the doc's office.
Or the doctor's offices can install those lovely hair washing stations -- nothing is more soothing (to me, at least) than a scalp massage with hot water. Then take the patient's blood pressure, and after that, tell them how much their medical bill will be.
And no mention of bloodletting so far, or in the article? Per Wikipedia: The red and white pole outside barber shops references a time when barbers were expected to perform bloodletting and other medical procedures to heal the sick; red may have represented blood and white may have been bandages. [Citation needed, because really, I'm gonna need to see a cite for that.]
posted by filthy light thief at 7:52 AM on May 24, 2018 [3 favorites]
I feel you AlexiaSky. I’ve always said medical providers somehow manage to do meaningful health care despite the Byzantine system that pays for health care. Almost every physician, nurse, counselor, social worker I know decides what is important to do to serve the needs of the patient first and then you do all the other stuff that gets you paid.
As this article shows, there are any number of creative ways to “do” health care effectively and they have precisely zero to do with how health care gets paid for. What’s been happening for years is that the number of stuffed shirts in cubicles who know nothing about health care, through whom money passes between me and my patients, is increasing linearly. Traditionally there was some token physician among senior leadership of insurers, benefit managers, and health care organizations but even that is disappearing and even when there is a token physician they are either not being listened to or they’ve abdicated their ethics to make sure they get their slice of the pie.
Where we’re at now is that the system is so top heavy, there is literally no time in the exam room to do health care and get paid and to keep our jobs we just do the getting paid stuff. And now a group of barbers on a shoestring grant budget without forms and malpractice and billing and coding are able to implement a more effective screening program than legions of MBAs and physicians can. It’s like the people who are buying fish antibiotics on Amazon. The whole system is a total farce and I think we are only a few years away from its total obsolescence.
posted by Slarty Bartfast at 8:42 AM on May 24, 2018 [1 favorite]
As this article shows, there are any number of creative ways to “do” health care effectively and they have precisely zero to do with how health care gets paid for. What’s been happening for years is that the number of stuffed shirts in cubicles who know nothing about health care, through whom money passes between me and my patients, is increasing linearly. Traditionally there was some token physician among senior leadership of insurers, benefit managers, and health care organizations but even that is disappearing and even when there is a token physician they are either not being listened to or they’ve abdicated their ethics to make sure they get their slice of the pie.
Where we’re at now is that the system is so top heavy, there is literally no time in the exam room to do health care and get paid and to keep our jobs we just do the getting paid stuff. And now a group of barbers on a shoestring grant budget without forms and malpractice and billing and coding are able to implement a more effective screening program than legions of MBAs and physicians can. It’s like the people who are buying fish antibiotics on Amazon. The whole system is a total farce and I think we are only a few years away from its total obsolescence.
posted by Slarty Bartfast at 8:42 AM on May 24, 2018 [1 favorite]
Why, it's almost as if trying to run a health care system for profit hasn't resulted in the best patient care.
I'm shocked I tell you. Shocked!
posted by fragmede at 8:59 AM on May 24, 2018 [2 favorites]
I'm shocked I tell you. Shocked!
posted by fragmede at 8:59 AM on May 24, 2018 [2 favorites]
Interesting, I spent a chunk of last month in Tbilisi, Georgia and noticed that some of the public pay toilets utilize the woman working there to also provide basic health checkup services, I thought this seemed rather forward thinking and probably a good thing.
posted by Twinge at 10:43 AM on May 24, 2018
posted by Twinge at 10:43 AM on May 24, 2018
some of the public pay toilets utilize the woman working there to also provide basic health checkup services
Huh? Please do tell about this. Georgian Doctors moonlight as toilet attendants?
posted by Slarty Bartfast at 7:39 PM on May 24, 2018
Huh? Please do tell about this. Georgian Doctors moonlight as toilet attendants?
posted by Slarty Bartfast at 7:39 PM on May 24, 2018
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No disrespect to barbers. I have a closer relationship to mine than I do to my PCP.
posted by Slarty Bartfast at 9:56 PM on May 23, 2018 [2 favorites]