This is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus to use an image from my favorite sport, golf.  Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all my professional positions, including as press secretary in Washington, D.C. for a Democrat Congressman from Oregon (Les AuCoin), as an Oregon state government manager in Salem and Portland, as press secretary for Oregon’s last Republican governor (Vic Atiyeh), and as a private sector lobbyist.  This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write.  I could have called this blog “Middle Ground,” for that is what I long for in both politics and golf.  The middle ground is often where the best public policy decisions lie.  And it is where you want to be on a golf course.

The Wall Street Journal asks the question in this blog headline:  Why is it so frustrating to see a doctor these days?

My answer?

It isn’t, at least not for me in Salem, Oregon where I live most of the year.  I have lived there since 1979.

For one thing, this means that I and my family know the Salem area’s health care system, including know many of the medical practitioners who practice in our area.  Thus, it has become relatively easy to get access.

That’s just one person’s story.

Here is the way the Wall Street Journal described the general system:

“You struggle to make an appointment.  You sit and sit in the waiting room. You get barely any face time with the doctor.  Why is it so difficult?

“Despite years of efforts to improve efficiency and access, wait times to see a doctor have only gotten worse, amid a shortage of physicians in almost every specialty.  One survey found the average time to secure a new–patient appointment is approaching one month in 15 of the largest cities in the U.S., and another survey found more than a third of Medicare patients are waiting more than a month to see a doctor.

“At least half of patients report experiencing ‘operational friction’ — long hold times on the phone to reach a scheduler, difficulty getting a timely appointment and trouble accessing follow-up information, according to surveys from patient-experience firm Press Ganey.  Patients complain of endless time in the waiting room and little face time with the doctor once in the exam room. 

“Digital patient portals — which are supposed to help make scheduling, follow-up and communication easier — have been hard to navigate for both patients and physicians.”

The Journal goes on to report that “one of the biggest reasons for the frustrating waits is a shortage of doctors across the country — making it tougher to get an appointment and increasing the amount of time wasted in office waiting rooms.  Federal data show the U.S. is short 12,945 primary-care practitioners, indicating that less than half of primary-care needs are being met.

More from the Journal:

• According to the American Medical Association, plummeting Medicare-payment rates for doctors over the past two decades have pushed many independent physician practices toward financial ruin, while burnout has driven doctors out of the field or led them to cut hours. 
• All told, the AMA estimates more than 83 million people in the U.S. live in areas without sufficient access to a primary-care doctor, and many specialists are in short supply as well. 
• A large portion of doctors are nearing retirement. The Health Resources and Services Administration projects a shortage of close to 140,000 doctors in primary and specialty care in 2036.  All told, the AMA estimates more than 83 million people in the U.S. live in areas without sufficient access to a primary-care doctor, and many specialists are in short supply as well.  A large portion of doctors are nearing retirement age.

Still, amid all the frustration, there are some promising solutions that could make getting medical care less of an ordeal, even if the problem has not been severe for me.

Here is a summary of useful steps, including in each case a comment from me.

Making it simpler to schedule

Medical offices can be notoriously hard to reach, with patients finding it tough to break through automated telephone menus.

COMMENT:  For me, I have found scheduling to be fairly easy, including through a portal that carries subscriptions from all my physicians in Salem.

Cutting wait time in the office

Medical offices are using electronic-record data to identify staff and scheduling issues that are often at the root of the long waiting-room times, and are adopting time-management strategies to fix them.  More practices are creating a “digital front door,” sending texts to patients in advance with links to portals or websites where they can fill out forms, update medication lists, and confirm insurance coverage up to a week ahead of time. 

Another cause of prolonged waiting-room times is inefficiency in so-called “patient cycle time” — the amount of time from when a patient arrives at the office until the completion of the appointment.

One clinic began starting clinic times earlier in the day to decrease the volume of patients toward the end of the morning hours, and changed its medical-assistant schedules to ensure they were available to get patients into exam rooms at the beginning of the morning and afternoon clinic sessions.

COMMENT:  I have experienced all these steps to reduce waiting time and all have worked well for me, including going on-line to provide appointment details before arriving at the doctor’s office.

Getting face time with the physician

To make sure patients have adequate time with their doctor, practices are changing the way they schedule appointments, reserving longer appointments for new patients and annual exams, and shorter ones for follow-up visits that may not require as much time.

Virtual care is also opening up appointments outside the traditional doctor’s hours.  Oakland, California-based health system Kaiser Permanente launched its first 24/7 virtual on-demand program that allows members to connect on-line or by phone to a clinician.

COMMENT:  Face-time with a doctor matters and, lately, I have gotten all I need, including with such steps as those outlined above.

On-line time with a doctor also works for me, though, of course, such a process never occurs with urgent or emergent needs, nor does on-line work every time. 

It just tends to work on occasion.  And another important step – finding a way for doctors to get paid for providing real service on-line.

A tech fix for follow-ups

Patient portals were supposed to help in many facets of the patient journey, from making appointments to communicating with doctors and getting test results and referrals.

Federal policies now require health providers to share test results with patients at the same time their doctors get them.

COMMENT:  Of course, such technology systems often don’t work, at least for people like me who are not as tech savvy as, say, are my grandchildren.  But, when they work, which is usually for me, they provide useful information.

For example, when I have blood work done, I often get results on-line even before my doctor sees them.

So, I appreciate the work of the Wall Street Journal to highlight this issue and to provide quality writing.

I also appreciate that I have been able to access the Salem, Oregon health care system with relative ease.

PERSPECTIVE FROM THE 19^TH HOLE:  This is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus use an image from my favorite sport, golf.  Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all of my professional positions, including as a Congressional press secretary in Washington, D.C., an Oregon state government manager in Salem and Portland, press secretary for Oregon’s last Republican governor (Vic Atiyeh), and a private sector lobbyist.  This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write.

As I write this, it is Monday after Easter weekend.  But the reality of what Easter means to those of us who are Christians does not recede even as the “holiday” does.

Easter means that Christ has risen from the dead to give us a chance for a relationship with God the Father.

Think of it this way using THE CROSS as a guide.  The fact that Christ died for us on that cross, as the song lyrics go, “creates a bridge to cross the great divide,” and, in a fascinating turn of phrase, “creates a cross to bridge the great divide.” 

In effect, we are taken across the horizontal beam of that cross to a new life with Christ.

One of my favorite columnists, the late Michael Gerson, captured these real themes well in what he wrote to commemorate Good Friday.  I give him full credit for excellent words and thoughts.

“The story of Good Friday — the garden, the bloody sweat, the sleeping friends, the torch-carrying crowd, the kiss, the slash of a sword, the questioning, the scourging, the mocking, the beam, the nails, the despair of a good man — is an invitation to cynicism. Nearly every human institution is revealed at its worst.

“Government certainly comes off poorly, giving Jesus the bureaucratic shuffle, with no one wanting to take responsibility, until a weak leader gives in to the crowd in the name of keeping the peace. ‘What is truth?’ asks Pilate, with a sneer typical of politics to this day.

“Professional men of religion do not appear in their best light. They are violently sectarian, judgmental and turn to the state to enforce their beliefs.

“The crowd does not acquit itself well, turning hostile and cruel as quickly as an internet mob, first putting palms beneath his feet, then thorns upon his brow.

“Even friendship comes in for a beating.  The men closest to Jesus slept while his enemies are fully awake.  There is betrayal by a close, disgruntled associate.  And then Peter’s spastic violence and cowardly denials. The women — all the assorted Marys — come off far better in the narrative.  But Jesus is essentially abandoned to face his long, suffocating death alone.

“And, for a moment, even God seems to fail, vanishing into a shocking silence.  ‘My God, my God, why have you forsaken me?’ says Jesus, in words that many of his followers would want to erase from the Bible.  How could the Son of God be subject to despair?

“Consider how the world appeared at the finish of Good Friday.  It would have seemed that every source of order, justice and comfort — politics, institutional religion, the community, friendship — had been discredited.  It was the cynic’s finest hour.  And God Himself seemed absent or unmoved, turning cynicism toward nihilism.  Every ember of human hope was cold.  And there was nothing to be done about it.

“Then something happened.  There was disagreement at the time, as now, on what that something was.  According to the story, Pilate posted a guard at the tomb with the instruction:  ‘Make it as secure as you can.’  Then the cynics somehow lost control of the narrative.  There was an empty tomb and wild reports of angels and ghosts.  And the claim of resurrection.

“Even those who believe the body was moved must confront certain facts.  Faith in the figure Rome executed has far outlasted the Roman Empire.  The cowardly friends became bold missionaries, most dying torturous deaths (according to tradition) for the sake of a figure they had once betrayed in their sleep.  The faith thus founded has given the mob — all of us, even the ones who mock, especially the ones who mock — the hope of pardon and peace.

“For believers, the complete story of Good Friday and Easter legitimizes both despair and faith.  Nearly every life features less-than-good Fridays.  We grow tired of our own company and travel a descending path of depression.  We experience lonely pain, unearned suffering or stinging injustice.  We are rejected or betrayed by a friend.  

“And then there are the unspeakable things — the death of a child, the diagnosis of an aggressive cancer, the steady advance of a disease that will take our minds and dignity.  We look into the abyss of self-murder.  And given the example of Christ, we are permitted to feel God-forsaken.

“And yet … eventually … or so we trust … or so we try to trust:  God is forever on the side of those who suffer.  God is forever on the side of life.  God is forever on the side of hope.

“If the resurrection is real, death’s hold is broken.  There is a truth and human existence that cannot be contained in a tomb.  It is possible to live lightly, even in the face of death — not by becoming hard and strong, but through a confident perseverance.  Because cynicism is the failure of patience.  Because Good Friday does not have the final word.”

Well written, Mr. Gerson, my late friend.

And, I say this on the day after Easter, which is a wonderful holiday – but more than that…a sign of hope for a future!