I walked into the exam room with great trepidation because I knew the patient was angry. He made many calls to my staff over the preceding few days expressing his ire. And, they in turn gave me a play-by-play of their interactions. But, I cut him some slack because his temper was not truly aimed at us, just misplaced from his true target of discontent. He just was unable to lash out at those who caused the current tempest.
“This is completely unreasonable. I am sick and no one is helping me,” he spurted out.
I agreed. “I realize how frustrating it is, but I tried my best” and I was speaking the complete truth as I said this to him. “But your insurance company simply will not approve the MRI. We did the prior-authorization and it was denied. And then, we appealed it and appealed it again”.
While the patient was somewhat mollified at my position in his diagnostic fiasco, I suddenly felt like a muggle in a muggle world. Too bad there are no wizards in the real world of medicine. Seemingly, ordering a diagnostic test on a patient often takes an act of courage, and requires a magical touch.
What the patient didn’t realize, and I would never tell him so as not to minimize his plight, I participated in the same scenario several times that day. When I was studying to become a doctor, no one informed me that the hardest part of diagnosing diseases would be the battles I fight with insurance companies to get medical services covered for my patients. It is not that I want to run amok writing orders for tests to drive up the costs of healthcare dollars. I simply yearn to do the best by my patients, to give them the best care and not to miss any nasty diseases. It may seem commonsense but from my communications with many insurance company employees, I think the goal of medical care flies over their heads.
The patient asked what we could do. Feeling overwhelmed and suspecting that the suggestion to climb a mountain and scream at the top of our lungs would not be well accepted, I altered my treatment plan.
“You know, sometimes specialists have better luck getting MRIs authorized than primary doctors do”, I told him hoping he would go for this option.
But, in my heart, I knew it was not the best option or the best treatment. For one thing, in my area, it can take weeks to get in to see certain specialists. While this may not seem like a long time, for someone experiencing pain it can represent a lifetime. Also, it may be the wrong specialist I am referring my patient to. In contrast, with the MRI results in hand, I would know exactly which specialist to send the patient to or even if he really needed to see one. At this point, my hands were completely tied and telling the patient, “I don’t know” felt like losing.
He looked hesitant then spoke: “I guess that is what we have to do. I wish I could get the MRI and come back to you. I trust you”.
And with that, the alternate plan was set in motion, against both of our wills and desires. The insurance company forced their decision onto this medical quandary. And persons with little medical training decided, without seeing or even talking to the patient, on how he would be treated. So much for the doctor-patient relationship!
Many people, doctors and patients alike, believe there is nothing that can be done to fix our fouled up healthcare system. Rather, we are on a roller coaster racing to the pit of medicine for the élite or worse yet, socialized medicine. Health disparities already exist in our system: just try to refer a Medicaid patient to an orthopedist or other specialist and you will see. Unless we do something to change our doomed course, medical care will not be available to everyone, even those paying for their own premiums. It will evolve into a system where only the very élite can receive medical care, and even then not all services will be available to them. The gulf of healthcare disparities will widen, leaving many without any care at all.
Are you going to stand up and help take back healthcare?
© 2016, Linda Girgis MD. All rights reserved.