The way in which health care is delivered has certainly changed over my more than 40 years of medical practice. My overall observation is that the fragmentation of medical care has created tremendous stress on our patients. Most patients have trouble finding a primary care physician, or rarely see the same physician or health care provider each time they have an office visit. The emergency room is often the only source of acute or off hours care. Specialty offices are just that, often with little concern for other systemic issues. When patients go to the hospital they usually are taken care of by a hospitalist, who does not know them or any of their special needs or issues. The past medical history is only what can be derived from the electronic health record. The patient’s specialists are not always consulted during the hospital stay.

Patients now are often at odds with their insurance companies who delay or deny tests or medications that the physician feels are needed. Our office uses considerable time, both from the staff as well as the physicians, talking to insurance companies as we try to get the patient care we feel they need. Communication has been reduced to electronic notes and it seems the days are gone when most physicians talk to each other about their patients.

Patients have reacted to this fragmentation stress, and are rightly disgruntled with the system. Just wanted to let you know that I feel your pain, along with my own.