Have you ever wondered what really goes on behind the scenes in healthcare? It’s a complex and ever-changing industry that involves a wide range of professionals, from doctors and nurses to administrators and insurance providers. Behind the scenes, there are many factors that impact the cost and quality of healthcare services.
We’ll take a closer look at some points you may not have considered. Whether you’re a patient, caregiver, or simply curious, you’ll gain a deeper understanding of things that take place even if you’re unaware of them.
In This Article
Our View vs. Reality Behind the Scenes
The healthcare industry is heavily regulated by government agencies and professional organizations, which can impact everything from treatment protocols to the types of medications that are available.
The problem with this is that cost creates a large part of healthcare consideration. It is a business model; however, to an ailing patient, it’s supposed to bring a solution.
Mixing these two creates circumstances where we often feel let down or that we have received subpar intervention. When we enter a healthcare situation with the simple view that treatment is needed, we expect the best outcome.
All to often there are gaps, sometimes large, in health situations. It’s unfortunately bound to happen when you mix expectations with processes driven by an entirely separate governing body.
Beyond the business and cost aspects are points to realize about medical professionals, office visits, hospital stays, and healthcare in general. We’ll look at some of these to give you more clarification and a peek behind the scenes in healthcare.
Visits with Professionals
In today’s fast-paced world, it’s often essential to communicate your thoughts and ideas in as few words as possible. This is especially true when it comes to presenting problems. Concise communication is not only easier to understand, but it also helps to avoid confusion and misunderstandings.
This is no different when it comes to a healthcare visit. When you present an issue in a clear and concise manner, you make it easier for a healthcare professional to determine a solution.
Using direct descriptions and even percentages for measurement are helpful. Additionally, being mindful of these steps shows that you respect the professional’s time.
Remember that less is often more and strive to keep your communication to the point which allows greater focus on the situation at hand. It creates a better relationship with your healthcare provider and promotes less distraction.
Productivity Driven Outcomes
Productivity is one aspect of healthcare behind the scenes that’s usually a sore subject with professionals. Efficiency is a must in all areas of healthcare, but it can often lead to lack of quality.
Depending on which healthcare arena you’re considering, productivity is usually the driving force behind treatments, coding interactions, scheduling patients, and outcomes.
For many professionals, it’s an unfortunate distraction that takes away from the actual steps they would like to administer during intervention. An oath is taken to treat patients with the utmost care, but the reality of productivity often creates obstacles.
To professionals, it’s not intentional, nor preferred, but they’re often told how to handle situations. This truth cannot be admitted but does happen. It’s often to their discretion if they fight it or not.
Insurance Reimbursement Rates
Another important factor in this discussion is the role of insurance companies in the healthcare system. Insurance providers negotiate rates with healthcare providers and often have strict guidelines for which services are covered and can limit our access to care.
Insurance is a common way to pay for healthcare services. However, it is important to be aware that sometimes insurance companies may only pay a portion of the total cost of the service, leaving us responsible for the remaining balance.
In addition, certain clinics or service providers may only accept certain types of insurance. This unfortunately limits the quality of care for the patient in several circumstances.
Another unspoken is that some companies encourage specific coding to increase reimbursement rates. There’s also the attempt to increase specific treatment parameters to improve the return that is received from care.
How does this happen? Whistleblowers often receive retaliation although training specifies this is not allowed. Within the system, professionals look the other way due to the sheer volume of instances that happen on a recurring basis. If they speak up, they fear ramifications.
You may have heard of lawsuits where companies were cited for misuse of billing or reimbursement. Once an investigation takes place, there are usually numerous accounts of mishandled situations that are detected.
Big Pharma Behind the Scenes
It’s no secret that the pharmaceutical sector is a multi-billion-dollar industry. Everyone involved wants their piece of the pie.
So how does this mesh with healthcare? Representatives from pharmacy companies visit physicians’ offices and other practices to “peddle” their products.
Although it’s not advertised, there are multiple situations where a professional will subscribe medications based on their relationship with a vendor. While some parameters and specific behaviors may be deemed inappropriate, under the table kickbacks do happen.
These reps make good money to travel to a variety of clinics, offices, and settings to make a convincing plea to use their product. All the while, the companies stick it to the consumer by gouging prices beyond what is affordable to most.
It’s another example of cost and a business entity running the show in healthcare.
Telemedicine and a Changed Landscape
It is well-known that widespread illness can create hardships in the medical field. During several years in reaction mode from a pandemic, the use of telehealth jumped to a rate like never before seen. It allowed us to safely continue receiving care, but also created an avenue to reach those who may not readily have access to healthcare visits.
Although in-person visits have returned, telemedicine still provides a way to reach some that cannot physically attend in person. But it doesn’t mean that all services are appropriate for this approach.
If you need specific services, telemedicine may not be a good idea. This might include labs, imaging, testing, certain assessments, and any physical intervention. A decision should be made by your professional if telehealth is the right method.
However, it’s vital that you advocate for your own care and follow your instincts if a telemedicine visit doesn’t address your concerns. You always have the last say.
Internet is Not the Answer
With so many advances in technology comes the ability to acquire almost any type of information. But it’s important to remember that it may not always be accurate or pertain.
Healthcare professionals are often questioned about points found online or ones that a patient heard from others. It’s not uncommon for us to self-diagnose before ever stepping into an appointment.
While knowledge is good, it can sometimes be unhealthy. Entering a health situation with preconceived notions or assumptions can be detrimental to the outcome of a visit.
It’s good to remember that the same information you have access to is available to professionals. In addition to their training, if it’s needed, it can easily be found.
Your advice or interjections often veer the conversation away from where it should be to diagnose or treat your actual health situation.
If you must research, try to allow the professional time to first discuss the issues without attempting to lead them toward what you’ve read. It’s more important to have reliable information from a professional.
Real Story Behind Nurses
This one is no secret. Nurses are the backbone of the healthcare system, often working long hours in stressful and challenging environments.
Despite their critical role in patient care, they usually receive less recognition and credit than they deserve. Nurses are responsible for much more than just administering medication and monitoring vital signs. They also provide emotional support, educate patients and families, and coordinate care between different healthcare providers.
It’s often the nurse that catches a doctor’s miss, adds input to quality care, or creates a successful situation between the physician and patient. In addition, during hospital stays, the nurse is usually more familiar with your situation than the doctor.
Many people overlook the hard work and dedication of nurses. An interesting point is that if you ask a doctor, they will usually tell you they couldn’t excel without the dedication of the nurses around them.
They Can’t All be Wins
When we spend time with a health professional, our view is only one angle. Often, we don’t consider what it’s like from the other perspective. What about the person that sees patients over and over throughout the day?
The reality is there will be unfortunate occurrences with some patients. Every visit and test outcome can’t be good news.
Most of us have blinders on when it comes to dealing with our own health situations. We expect answers and healing and usually assume it will end well.
This truth doesn’t usually resonate until we’re on the receiving end of difficult news. Health scares and issues aren’t planned nor received without a gamut of emotions. Imagine the point of view of the professional delivering the information.
Being a part of those difficult situations over again can be stressful to healthcare providers. Their livelihood is to keep us healthy, but it isn’t always possible. Some professionals cope better than others which leads to our next point.
Growing “Medically Cold”
This isn’t an actual medical term, but it’s a real mindset. After continuous exposure to dealing with illness, the idea of becoming “used to” seeing issues and delivering bad news is real.
Certain employees are in settings where they readily deal with death, trauma, or prolonged illness. These professionals usually have unique ways of coping with what they see on a daily basis.
It’s not uncommon while having these encounters, even in less traumatic settings, to become “cold” to the emotion that would normally accompany the situations. It’s not due to an unfeeling person or a narcissist, but simply the point of seeing these occurrences time and again. Their brain becomes somewhat numb to it over time.
The issue with this is that patients may detect it. However, it’s not personal nor an uncaring or emotionless professional. It’s only from continuous exposure.
This mindset is similar to burnout. Taking stress to the next level is when this occurs. Overwork and fatigue can lead to this mindset and create situations where a healthcare provider seems mentally removed.
Seeing Patients as Individuals
Along with growing “cold” to what they constantly see, professionals can readily view a problem as just that rather than keep an eye on the whole picture. This often happens when someone has been practicing in healthcare a long time.
Once they’ve seen repeat circumstances, it’s easy to relate these to each other rather than allow time to focus on the whole patient. There are certain steps taken at most any physician visit, but occasionally something can be missed based on a less than thorough assessment.
It’s important to advocate for yourself if you feel this is taking place. You’re not a number and should be listened to with consideration. Don’t sidestep discussions that need to take place simply because a professional attempts to reassure you they know the drill.
Mistakes Happen Behind the Scenes
It is a well-known fact that doctors are highly trained professionals who strive to provide the best possible care to their patients. However, like any human being, doctors can make mistakes.
Errors can range from misdiagnosis to prescribing the wrong medication and can have serious consequences.
Along with being human, fatigue and high caseloads can lead to mistakes. We’ve mentioned monotony which can cause distraction from looking at every case with a fresh view.
Unfortunately, you don’t decide your healthcare treatment when a doctor is consulted, but you can decide to follow-through. It’s important to communicate continuously about your care and determine if it’s appropriate.
Don’t shy away from a tough discussion if you think a mistake has been made. Otherwise, it might continue or could even happen to someone else. Be proactive in watching every prescription and researching interventions as they are recommended.
Healthcare Professionals are People Too
Doctors dedicate their lives to helping others. However, it’s important to remember that they are people too. They have personal lives outside of work, families, and even their own health concerns.
Being a healthcare professional is a very demanding job, emotionally and physically. They work long hours, deal with high stress situations, and are constantly learning and adapting to new medical advancements. Resilience is key.
It’s easy to assume “that’s what they signed up for” or maybe decide the pay is good so their situation is acceptable. The truth is quite the contrary due to the parameters that exist through a career in healthcare.
While well-trained, medical professionals gain most of their understanding with practical intervention. This means they learn from what they see and the experiences they have, just as we do.
Even the best training can only take a professional so far without application. Time with patients is where the real lessons happen.
So, while we should appreciate and trust medical professionals with our health, it’s also important to remember that they are human beings.
Final Thoughts About Healthcare Behind the Scenes
We’ve looked at several points about healthcare that raised questions of quality and safety. It’s merely to give you insight into healthcare behind the scenes and not to judge or negate the abilities of professionals.
We assume at least the status quo and might even expect great outcomes when we encounter professionals. Being your best advocate is good advice when seeing any healthcare professional. After all, there are some interesting practices that take place behind the scenes in healthcare.