Now and then I share the experiences physicians witness, even in their own nor family's care. For them it is also a challenge. Pity the ordinary patient citizen.
I received an email from Doximity, a closed professional social media site restricted to physicians. On Doximity we all share elevator talk...the few seconds of intercourse discussing patient experiences among peers. (probably illegal under the shield of HIPAA regulations. These regulations have become more than burdensome, because they do effect patient care.
This story spells out one or more such situations a physician experiences in his own care or that of a friend or family. This process consumes an inordinate amount of time during an appeal process. One case in particular concerning a serious lumbar disc illuminates the tension of reading a guideline of prior treatment pursuant to approving a request for an MRI. MRIs by the way are considered standard practice for serious back injuries. Prolonged herniated disc problems often lead to permanent nerve injury and disability.The insurance company insisted on a six week waiting period before an MRI was approved. Their decision is based upon the fact and MRI costs $ 1,000, not the welfare of a patient.
From a Medical-legal standpoint this places the physician in jeopardy, despite his order for an MRI. Had the patient presented at an emergency department an MRI most likely would have been ordered. And since it was in an acute emergent condition it would have been pefrormed immediately and without a prior authorization. The risk of a legal incident in the emergency setting would pre-empt any decision by the insurer. The hospital or MRI center would be the loser if an insurer retroactively did not authorize a payment. (they do not like losing money with smaller margins.). The insurance company is under control, unless the physician insists using his authority to protect the patient.
This scenario occurs multiple times a day for most MDs. It is a major cause for burnout, which most patients are aware occurs often early in a physician's career.
Many articles now discuss the rising tide of physician burnout, and suicide. How can it be prevented?
The loss of physician authority and the complex tension between advocating for the patient and the bottom line for health insurers creates a conundrum for the doctor. She (he) has been placed in a repeating cycle of conflict, a chronic emotional enui leading to a similar state as PTSD.(post traumatic stress disorder). Only in this case it is not post-traumatic, it is ongoing on a daily basis.
This may be the primary cause for physician burnout and suicide Doctors have been trained to work long hours and to deal with emergencies, even in the middle of the night.
Read the entire article here...
The Illicit Perks of the M.D. Club - The New York Times
Next time you are denied a test or procedure, call your insurance company and protest vehemently. You probably won't get very far.
Insurers must share liability for thier medical malfeasance...It must not sit on the shoulders of your physician.
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