When a patient sees the doctor for whatever reason, there is an expectation about who is in charge of any healthcare decisions. Few would argue that patients and doctors should jointly make any healthcare decisions together. Ideally, the doctor gives the patient knowledge about certain medical conditions and then the patient makes an informed decision. Sure, there are some doctors who patients feel are too paternalistic. And in a similar vein, there are patients who are truly passive in their own healthcare. But, who holds the reins of healthcare?
In order for a patient to receive care they need, there are many hurdles they need to go through until they actually receive. Even when the doctor and patient agrees upon a course of action, it often gets shot down by 3rd parties.
How do third parties hold the reins of healthcare?
- One of the ways is set into play before a patient even steps foot inside the exam room. This is done through clinical guidelines insurance companies establish in order to cut costs. It basically is an instruction plan that can be followed whenever a patient suffers a certain condition. However, diseases don’t read textbooks and often veer off course. Insurance companies do not, their paths are set.
- After a doctor and patient decide a diagnostic plan such as ordering a test, more often than not, an approval is needed from the insurance company. It doesn’t matter how much pain you are in or how much you are suffering, the approval process usually takes several days. Sometimes, they may come back and request notes from the office visit. If that happens, the approval process can take weeks. At this point, the doctor or patient no longer holds any control of whether the diagnostic test will be done. It is completely in the hands of the insurance company to decide whether or not the test will be approved. It doesn’t matter how many phone calls are made. The only option is to wait and hope for a favorable outcome.
- Most people do not like taking medications but it is often needed. Your doctor prescribes you a medication which he/she feels you need and after discussion of it, you agree. Next you go to the pharmacy to pick up the said medication. Unfortunately, your insurance company decided they would not cover it. You can pay out-of-pocket but often the cost of prescription medications are grossly inflated and you cannot afford it. You can ask for a medication that your insurance company will approve. This requires the pharmacist calling the doctor and changing the medication. Nothing wrong with that but it will consume your time and often the doctors does not have many choices. You end up with the best medication the insurance will cover, not the best medication. Sometimes this doesn’t matter but sometimes it is a big difference. Certain medications require authorization from the insurance company. And this can take several days again and many phone calls.
- Your doctor and you decided you need surgery. But, it is not so simple as scheduling a date and reserving an operating room. As you can probably guess by now, this often requires an authorization from your insurance company.
- Ever fallen and broken an ankle or foot? Sometimes, depending on the severity or site, your doctor may suggest you use a wheelchair for a certain period of time. But, you aren’t getting that without an authorization from your insurance company.
- You are seeing your primary care doctor for a certain problem. He/she suggests you see a specialist and gives you a referral. You go to schedule an appointment and find none of them on the insurance companies’ list is taking your insurance any more.
There is much talk about the doctor-patient relationship. Sure, there is often need for improvement in that arena. However, it is no longer the doctor-patient team who is in charge of healthcare decisions being made. Third parties now hold the reins in the healthcare system at large, as well as in individual patients’ care. Their decisions are based solely on cost-containment. All too often we accept the decisions and grumble to those who will listen. But, this is no longer acceptable. They hold the reins and are not entitled to. They did not receive the medical training to be making these decisions. Will we let them continue holding the reins to our very health? Or will we raise our voices and fight back?
Copyright secured by Digiprove © 2016 Linda Girgis, MD, FAAFP
Excellent post. Five stars. The loss of medical diagnostic and therapeutic decision making for both doctors and patients is tragic. And scarey. These insurance company and CMS (Medicare,Medicaid) assaults against physician-led US medicine and surgery drives patients (and some providers looking for cash supplements) into unvalidated alternative medicine scenarios. Very dangerous. Too bad that the US healthcare system under ACA care is costly, inefficient, and gives unnecessary patient suffering and anguish to conscientious physicians and surgeons. Vote in 2016 for CHANGE!
It will be interesting to know, WHEN did doctors and patients stop holding the reigns. (For quite some time.)
And I thought the Canadian Healthcare is in dire need of an overhaul!
It is. The ailments are different to certain extents, therefore the treatments will also differ to fix the two systems.
Down south it’s the 3rd party Insurance companies and HMOs or eq, here its layer upon layer of bureaucracy. We’re blessed with en enforced “wait”-period for most anything medical: weeks, but usually months.
The sad reality: the person we’re aiming to serve or cure or heal: THE PATIENT, is no longer the NB person in the room.
Are the systems fixable? Certainly.
Is there the political or monetary will to do so?
I don’t think so.
Since you’re not playing along, you’re accused of not being a “team player.”
But, we can be silent no more!
Thank you for the post, Linda!