Table 3 Health System Factors

Problems navigating the system

I think the systems are completely broken and completely just un-navigatable… I have a Master’s degree, and I have trouble talking to the County Assistance Office. Think of the people that are actually using the County Assistance Office as their lifelines, if I can’t get through, if I have to wait days for a phone call back, what do you think those people are doing?

I think there’s a misconception that if you have a primary care doctor that you're not gonna have any problems and everything’s gonna be fine and you can get an appointment tomorrow and that’s just not true. So whether you have insurance or you don’t have insurance there’s still – the systems are very hard to navigate…

It seems like patients, are, they fall through the cracks.

It’s not just I don’t have insurance, I’m not going anywhere; I have insurance and going somewhere. There’s people with insurance or Medicaid and then they go to get their insulin and their Medicaid got turned off for no reason without documentation, no phone call or mail to say that, and then they can’t get their insulin.

Lack of understanding of value of primary care

They do not understand the importance of having a primary care physician, what his role is, and how important it is to them maintaining your health and getting them the treatment that they need. So in their minds they can get this treatment without, they don’t know what they have one for, and so primary care physicians, going to the doctor’s, that kind of thing, it’s just something that is absent from them. And when they do take the time out to go to these doctors, it’s not good experiences, and I think because they’re not able to say what they mean and doctors don’t have the time to coach you through it.

Emergency department as learned behavior

Or they feel as though why waste my time going to the clinic when the clinic is going to send me – well the doctor at the clinic or my doctor is going to send me to the emergency room anyway, so I just don’t even bother with him and go straight there.

I think patients rely too much on the emergency room for things. And some of that is just trained behavior. It’s, they, for example, patients that don’t get their medicine and they run out of it and they come to the hospital and we give it to them. So they learn that, oh, well, I’ll just go to the hospital and get it.

If a patient calls and says, I’m short of breath, they (home care) say, go to the emergency room. Oh, we can’t send a nurse there to do emergency visits, which, they can’t. So those patients all fall through the cracks and they come in. The same with the primary care physicians’ offices. They’re overbooked, they’re very busy, the primary care doctors are in their offices, they’re in the hospitals, they’re running all around. When a patient calls with a bad problem, they say, go to the emergency room, we can’t see you here.

Discharge instructions unclear

Because when you’re being discharged from the hospital, it’s a blur of you talk to 10 different people about 10 different things and then you finally get home, and you’re like, wait, what? Why am I weighing myself?

I think a lot of people say they understand because they don’t wanna come off as being – appearing stupid or intelligent, but they just also are overwhelmed by the experience and by whatever – maybe is being asked by them when they leave the hospital.