June 11, 2022

Mutations, mutations…

I’m behind. I should have written an entry a couple of days ago. I do my best to write at least two of these musings a week, unless life is really intervening. I failed at it this week. I suppose I’m still in recovery mode from the last show plus I had to use a number of my evenings this week to run around and see all of my friends shows (most notably local productions of Kinky Boots and The Sound of Music). I’m also in that weird headspace where I’m still trying to sell Volume I, editing Volume II and realizing that what I’m writing now will be Volume III if I choose to keep this project moving forward.

At least current Covid numbers are suggestive that there will not be a Volume IV. I will be able to take my imagination and my thoughts and apply them elsewhere. Maybe a novel, maybe a play. Maybe I’ll just get drunk on apple wine. In the meantime, however, I still don’t think we’re completely out of the woods. Coronaviruses in general become less active in the summer months and more active in the winter. (This is why you’re more likely to get a bad cold in the winter.) Some of our respite may be due to this natural cycling. If this is the case, things may start shifting again around football system when fall nips the air. The Covid coronavirus mutates about four times faster than the common influenza viruses and we are all familiar with how we have to get vaccines for flu every year based on the best educated guess as to the circulating strains. Sometimes we get it right, and the season is mild. Sometimes we don’t and it’s a heavy flu season. Is this where we’re headed with Covid? Annual shots and some good and some not so good years? There’s so much that’s unknown. Mutations, population behavior, politics, the ingenuity of vaccine manufacturers – it all adds in.

The official Covid numbers locally remain relatively low (and the number of people in the hospital with Covid also remains low and well within manageable limits). However, I hear of new cases among friends on nearly a daily basis. I think that some of that comes from these writings and the erroneous presumption that I must be some sort of Covid guru or Covid whisperer and so I get calls and texts and messages from everyone if they get sick and likely hear about it more than most. Most of my friends, long vaccinated and boosted, aren’t getting terribly ill and generally have been tested with home tests so I don’t think they’re being well counted by the public health authorities. And I think that’s likely happening most places as the pandemic slides into endemic mode – outside of some relatively narrow areas of study, it’s slipping from our daily consciousness, replaced by new worries about inflation, and gun violence, and war in Eastern Europe. I’ll take it, and the lessened burdens on health care and society, even if it’s going out with a whimper rather than a bang. I’m still not completely convinced, however, that there’s not at least one more very nasty surprise coming our way before it all runs its course.

I don’t think we’ve even begun to come to grips with what the pandemic has done to society over the last couple of years. We’re all too busy trying to restore ‘normality’ and making up for lost time to have the ability to sit down and take a sober accounting of how different things are from early 2020. I think some of the changes are too wrenching to fully comprehend. That’s certainly true of what’s going on within the health care system. The combination of loss of seasoned workers to early retirements or different ways of using their skill sets combined with the financial pressures placed on health care institutions is only just now starting to cause significant changes in the way business is done. What am I seeing? An acceleration of the system’s view of health care providers solely as revenue generating cogs in a large machine and significant pushes to increase and maximize that revenue at the expense of providers abilities – which basically translates into do more with lots less. Needs of patients and society are, at best, a secondary consideration as armies of administrators try to shore up the bulwarks of systems financially battered over the last few years.

The federal support that allowed health care to fight Covid has more or less come to an end. There’s not going to be more public funding of vaccines, reimbursement for indigent care, or extra payments to hospitals for their increased expenses going forward. And if there’s no money, there won’t be a lot of motivation to provide services. If another surge starts to take hold, response may be more sluggish than in the past. Congress could, of course, put additional dollars into public health but congress doesn’t seem to be able to do much these days other than conduct a cold civil war inside the capitol.

At the age of sixty, I’m getting a bit tired at being asked to do more with less yet again (this sort of thing happens every time there’s a downturn in the economy). I love my work. I love my patients. I don’t even mind tilting at the healthcare windmills out there but eventually it starts to all feel a bit much. I’m seeing a landscape where many of the support services I rely on – senior housing and health care facilities, home health agencies, meals on wheels etc. – buckling under a combination of inflationary pressures and the inability to hire and retain competent staff. This is combined with a rapidly aging population and the enormous boom generation right on the cusp of needing these services. It’s going to get really ugly over the next decade or so as more and more start competing for fewer and fewer available resources in a country with a fraying social contract and no political will to provide money for social programs for fear that someone unlike you might tangibly benefit.

Is the healthcare sector broken? It’s still intact but it’s frayed and needs some TLC in order to repair itself. If we define our system as the way in which those in need of health services are matched and receive proper treatment in a timely fashion, then yes certain things aren’t working too well. The numbers of aging adults means that specialty services commonly required by them are full up. It’s not unusual for me to be quoted a three to six month wait time for an appointment when I make a referral. Insurance programs, trying to staunch losses, are more likely to fight about the need for a service than in the past and that puts extra hours of work on my office staff. We’re out of IV contrast for certain X-rays preventing timely diagnosis (a supply chain / manufacture issue). Administrators are constantly looking for ways to reduce costs – replacing staff with lower cost/lower knowledge base individuals ensuring that more questions come up the ladder to me and my partners or no longer allowing us to launder white coats through hospital laundry. The little time sucks and aggravations add up. But, without some serious rethinking by those in positions of control, there’s going to be continued decline in human capital in healthcare for the foreseeable future.

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