Letters to the Editors

December 3, 2001

letters

 

Letters To The Editors

Jump to:Choose article section... How to handle utilization reviewers Releasing your rage where it counts

How to handle utilization reviewers

To family physician Gil Solomon's advice on dealing with utilization reviewers ["Insurance hassles: Don't get mad, get results," Sept. 3], I'd like to add two techniques I use.

When a clerk or nurse is reluctant to approve a diagnostic study or referral, always ask for her name and phone extension. Let her know that you will include this information in your patient's medical record, and explain that you will advise the patient to pay for the service himself since the insurance company overruled your best medical judgment. It's amazing how often a company representative has a change of heart when she realizes her name will appear in the chart.

When the reviewer is a physician, approach her as a colleague. Explain the patient's history and the rationale for your request, and ask what she would do in this case. By treating the reviewer as a consultant, I frequently obtain not only the authorization I need, but also some useful advice.

Richard J. Sagall, MDPhiladelphia

Releasing your rage where it counts

I agree with your editor, Marianne Mattera, that we doctors need to talk to everyone, everywhere, about the ills of managed care ["Memo From the Editor: 'Doctor Rage,'" Sept. 17]. But we should focus our anger on how patients are affected, not physicians.

While care is being routinely delayed by HMOs, people are getting sicker or even dying. The public needs to hear this, not how much money we make or how hard we work.

Jeffrey Michaelis, MD
Brewster, NY

Your editorial describing the plight of our profession is laughable. We doctors are among the smartest, best educated, and luckiest people on earth. To even suggest that we get up in front of a Rotary Club or other group to whine "poor me" is insulting.

If we've allowed managed care to take control of our profession, it's nobody's fault but our own. We have the power and intelligence to make the practice of medicine whatever we want it to be.

Please let me know when the next doctor is going to stand on his soapbox and whine. I have a bushel of rotten tomatoes ready!

Mark Goldstein, DO
Scottsdale, AZ

I overheard the following exchange when I accompanied my father-in-law to the ER. The speaker was an ER physician. I could hear him because he was yelling. The other party, who was barely audible, was a patient's husband.

Doctor: "I'll be with your wife in a moment, sir, but right now I'm taking care of other patients. Can't you see I'm looking up things on the computer?"

Patient's husband: (unintelligible)

Doctor (angry, exasperated): "I'll be there as soon as I can. She'll be fine."

Patient's husband: (unintelligible)

Doctor: "Look, sir, your wife is fine. She is not going to die. I know she's there, and I'll be with her as soon as I can!"

Unfortunately, this sort of performance is likely to have more of an impact on the public's impression of doctors than anything we might say at a Rotary Club luncheon.

Gil Solomon, MD
West Hills, CA

 

Edited by Liz O'Brien,
Associate Editor

 

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Liz O'Brien. Letters to the Editors.

Medical Economics

Dec. 3, 2001;78:6.