After spending a week of fighting and making multiple phone calls, I feel a certain victory in finally getting approval for a MRI I know my patient needs to accurately diagnose her symptoms. Until I realize that a week has been lost in initiating treatment and relieving this patient’s pain because of the red tape that now ensues after ordering specific diagnostic tests. And another stacks of medication prior authorizations wait for my review. The one in front of me is for an asthma medication. The insurance company is requesting that I change to a medication that does not even have the same mechanism of action. From my experience, I know my efforts at getting this medication covered will be denied. And my patient will be unable to afford the exuberant out-of-pocket costs. What typically happens is that the patient has to first fail on the alternative drug. What is a drug failure in the insurance company’s eyes is more like weeks of cough, wheezing, and not being able to breath in my patient’s. Gone are the days when doctors are able to do the best for our patients. Medical decision-making on many levels has been torn from our authority, to be replaced by case managers and insurance employees whose main goal is to keep costs down.
Few people would argue that the American healthcare system is in need of repairs. Our country has some of the highest medical advances and technology in the world. Yet, patients are not always utilizing these cutting edge treatments because inefficiencies in our healthcare system are preventing them from doing so. Patients are increasingly disgruntled at having services for diagnostic tests and coverage for their prescription medications denied. In some areas, it is even difficult for them to find access to doctors they need. Doctors are similarly disenchanted with their chosen careers. After long years of study and huge amounts of debt, they are finding that they are not able to practice medicine the way they truly feel is the best for their patients. Additionally, burnout rates among physicians are high as regulatory burdens rise, insurance companies make getting paid more difficult and reimbursements stagnate or decrease. Meanwhile, overhead costs continue to soar.
How did the best healthcare system decay to such a chaotic state? Many say it is the fault of doctors who do procedures for profit and are driven to make more money. Yet, only 20% of healthcare costs go to physicians and half of this 20% goes to covering overhead expenses. Contrary to some peoples’ belief, most doctors truly have the patients’ best interests at heart. We work many hours, much of it uncompensated. When your doctor sends your refills without making you come for an office visit or answers your urgent calls at 3 am, we get paid nothing for that. We do it because it is to offer patients with the best care. We are often on call over-night and holidays, many times for no additional pay. Sure, there are some outlier doctors who game the system. But, in my experience, this is a very small number.
Perhaps, the biggest damage to the healthcare system came with the arrival of HMOs. These are organizations that are designed to control costs, often by denying expensive care and medications. Keeping costs down is very important. However, there are some patients who need these procedures and medications. Yet, much is spent in employing people for managing doctor’s decisions so we don’t bankrupt the system. Meanwhile, the insurance company executives earn millions from this denied care and they are accountable to no one. While there is oversight on physicians’ practicing habits, there is none of how insurance companies profit. Perhaps, true healthcare reform should bring these companies under tighter scrutiny?
Another harmful effect on the medical system is the Big Brother regulations set in place by the government. Most people have heard the woes of Medicare and there are always predictions on when it will go bankrupt. It consumes much healthcare dollars without adding much quality to healthcare. Rather, these funds are put into increasing bureaucracy and red tape, for doctors and patients alike. For example, there is now a push to have EHRs in every medical practice. New guidelines have been published and criteria set that needs to be met. Unfortunately, many of the software systems simply cannot perform the functions the government is requiring for such things as their meaningful use program. Much money is being spent on refining and revising this, yet doctors all across the nation are crying out that their guidelines are not helpful and meaningful. And to input them into the patient chart, it takes time away from direct patient care. Is it better we spend time face to face with are patients listening to their concerns, or check marking the boxes in the chart that the government wants us to to meet their requirements?
These are just a few examples of what we have seen already but soon we are going to have a true crisis of access to care. More doctors are getting frustrated and retiring early or quitting medicine. The ACA has enrolled more insured patients. But, more doctors are not being trained. Who is going to take care of all these patients? Many patients turn to the ER when they can’t get in with their private doctor. ER’s are already over-burdened. Surely something must give before this leads to a true disaster.
While many things are broken in the healthcare system and many doctors dread going to work, patients are the biggest losers here. They are no longer seen as people but as consumers and people seem more concerned about their data. Doctors have made some attempts to change the system but have often failed to the big corporations. Maybe the only way change will come if patients do likewise and demand the level of care they deserve.
And as the pile of paperwork is completed, I head to the exam room to see the next patient. I remind myself why I became a doctor: for that patient waiting for me in the exam room. That patient will never be a consumer or a set of data to me but rather a person who entrusted me to help make the best medical decisions for them. And I will continue to fight the broken system every day, no matter what it takes, because patients deserve better than what they are receiving.
