The Doctor is in But Not Your Doctor

I walked into the exam room and introduced myself to the new patient waiting there. He immediately told me that he was only there to get a referral because his regular doctor could not do it. My understanding of the situation was that while his doctor could remain his primary care provider, he was out of network and a referral to an in-network doctor was not allowed. While his doctor remained available to him, he was not totally capable of doing everything this patient needed to be done.
The doctor in the emergency room recently diagnosed the patient with a certain type of cancer. His diagnosis required a timely evaluation by an oncologist because it appeared the cancer had spread. The patient was told to follow up with his primary doctor who then told him he could not refer him. The patient spent the next 2 weeks making phone calls to find a doctor in his network who was willing to evaluate him in an expedited fashion and refer him onward. And finally he found me.
Upon asking him his medical history, it became apparent that he was not so interested in me being his physician. He just wanted that referral paper so that he could be treated for his newly diagnosed cancer. I felt rather like an office clerk validating a parking stub. He left the office with a referral and I doubt I will ever see him again…..until he needs another referral. But, what I am being asked to do is not appropriate care of this patient. As a primary care doctor, I should know all his medical history and receive feedback from the specialists. However, in this case, I am merely a secondary doctor.
In my mind, this process is completely unnecessary and wasteful. The patient’s primary care doctor is quite capable of deciding when a referral is needed. But, the insurance company put a hurdle in the way and required him to see an extra physician. This was an unneeded cost and made the time for the patient to see the oncologist much longer. And with a full practice, my time would have been much better served treating a patient who needed me for more than my stamp on a paper.
Decisions like this happen every day in doctors’ offices across the US. Much of what is being done in the name of cutting costs actually drives up cost. In this example, an extra new patient office visit was paid to me just to be a paper clerk. While I am not complaining about getting paid for easy work, I do object to the fact that those who are the loudest regarding cutting health care costs are actually the ones most responsible for the waste in the system. When is anyone going to call out these third parties to cut out their own waste and abuse of the system? While all eyes are on doctors and hospitals, insurance companies pretty much possess free rein to do whatever they wish.
No one can argue that healthcare costs are out-if-control in the US. However, if we truly want to curb these costs, we need the insurance companies to take some responsibility in it as well, and not just by allowing them to abuse providers in the system. These companies need to be called to task and called on to stop making a mockery of the system. Do we want patients who are empowered to make their own healthcare decisions? Or is it just good enough to place our very hearts in the hands of third parties and hope they don’t cause them to arrest? The doctor may be in, but if he/she is unable to give you he care you need because of third-party interference, does it really matter?

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