Health Status of Current U.S. Health Care: Two Cases in One Week

I have my solo cardiology practice for the last 15 years in Batavia, a small town halfway between Rochester and Buffalo, NY. I do see a fairly significant number of people with multiple cardiac problems. This area is served by good many internists, family physicians, Physician Assistants (PAs) and Nurse Practitioners (NPs). There are some PAs and NPs who work independently under the coverage and guidance of some other internists. For the last many years now we have a group of hospitalists working in the local hospital and for the most part, they do an excellent job serving the need of the hospital and the patients. Due to the economic pressures, health care costs and political reasons, the hospital and physicians have been trying to find the ways to spend less and save more money. Many health insurance companies and the health care experts have been pushing to have more of PAs and NPs serving the population. Yes, with various guidelines in place, anyone can read them and try to follow them. However before any treatment can be offered to the patients, the right diagnosis needs to be made and that is where the real role of an MD comes. The health insurance companies, PAs, NPs, the computers and the guidelines cannot replace a well-trained MD and an expert in the specific field of medicine. That is what I will try to show by the following two real cases that I saw in one week in this small town. 1. A 61 year old white male admitted to the hospital on a Saturday due to the back and some chest pains. He said that while walking and then playing with his dog, he developed very intense back pains and some chest discomfort which eventually brought him to the local emergency room. His symptoms were relieved by Nitroglycerin paste. His ECG showed markedly inverted T waves in lead V2-4. There was no old ECG available for comparison. He claimed to see me about 8 years ago once in my office and since then he never came back for follow up. I was informed of these findings by the ER physician and he was hospitalized in stable and chest pain free condition. I was supposed to see him next day, Sunday in cardiac consultation. I arrived at the hospital next day around noon to see a few patients in cardiac consultation. I wanted to start with him first because of his history of chest pains and the abnormal ECG the night before. After I arrived in his room, he was dressed up and ready to leave. Discharge papers were given and signed! I introduced myself to him and then I listened to his story and saw his last night and morning ECGs. His story was suspicious for Acute