Inside the exam room, patients share all their ails and fears with me. They depend on me to guide and help them. In their eyes, I am a healer and the one they look to for a cure. Often, they tell me their successes and joys in life. But, what happens on the other side of the exam room door often disrupts the good that is achieved inside the exam room.
On the other side of the door, people are making decisions that are not based on good patient care but rather maximizing profits. Some of them are seeking to use the patient inside the exam room to gain victory in their own political agendas. Those on the other side of the exam room door never took an Oath to do the best by patients and are not bound by ethical constraints. They hold no liability in the decisions they make regarding patient care and cannot be held responsible for making wrong or irresponsible determinations.
Inside the exam room, the doctor and patient seek to find relief from suffering and cure from diseases. But, on the other side of the door, lies in wait those who focus on cost containment and clinical pathways. They do not need to know or understand the patient to make their judgments on patient care. They do not even have to care. They are just doing their jobs after all, outcomes based on finances.
I wish to stay behind the closed door with my patient and do what I was trained to do. I have no desire to open the door and face the pressure of the fight to get coverage for medications and tests my patients need. I know what waits for me on the other side of the door, and it often frightens me. Once I open the door, I let in these outside forces that attempt to harm my patients, more by ignorance than anything else.
Inside the room, my patient is a person, a human being with special qualities that make them unique. On the other side of that door, they are a commodity that others fight over to gain control over them, and their financial potentials. The wolves wait outside the door, wishing for their own gains. They hide themselves with the costumes of patient care. But, anyone who lifts the mask will see these third parties and politicians who are waiting to devour the patient for their own benefit.
My patient and I decide a treatment plan, yet once the door is opened, that plan often gets torn apart, Prior-authorizations kill many good strategies and deny patients many real cures. Tumors grow, pathogens kill, yet those outside the door pay no attention. Once the patients steps outside, the clinical goal is under attack and most often seized.
I cannot stay locked inside forever. I know I must open that door and I feel the slings of outsiders as soon as I turn the knob. While those wars hurt, my patients are dealt the severest blows. We must learn to walk out the door together and bear the onslaught hand-in-hand. In isolation, we shall surely be defeated. But, if we stand strong as we exit into the battleground, we will find some hope to slay the beast.
Copyright secured by Digiprove © 2016 Linda Girgis, MD, FAAFP
