The Way I See It
I usually avoid reading editorials related to healthcare, since most of them hang with me like a bad burrito. I sputter and fume until I can no longer stand it, and then, at some ridiculous hour of the early morning, I rise and try to rid myself of the acid taste at the back of my throat by pounding on my computer's keyboard, writing one more letter to the editor. I suppose I could just stop reading those editorials, but they draw me like a moth to a flame.
One that I read not long ago deserved some credit for being less silly than most. It successfully identified the motivations that bring doctors to primary care-our love of independence and relationships. But then lots of footnotes started showing up, the editorial citing theories suggesting that we family practitioners were misplacing blame for our problems and ignoring our own errors. We had focused on financial rewards; abandoned small, patient-centric practices for large multispecialty groups; and failed to control our destiny. We had sacrificed our future and much more.
One of the editorial's assertions was that we had sold out continuity of care for the higher reimbursements of managed care plans. Primary care physicians, it said, willingly jumped into the two-step conga line inherent to competition between insurance plans, and joyfully participated in the never-ending shuffle of patients between doctors. We evidently did so because it created a pseudo-population of new patients, and somehow this brought us increased reimbursement.
Let me cite my own experience, even though I can't attach one of those little footnote numbers to it: Several years ago, my practice was offered a managed care contract that hit us right in the chops with a miserable reimbursement schedule. We initially turned it down. Then we were besieged by a number of patients who were teachers in a local school district that had changed to this particular insurer. After much soul-searching, we offered to sign on with the stipulation that we would under no circumstances take any new patients except the teachers, since they'd been with us for many years. The insurer agreed.
One afternoon several weeks later, my medical assistant told me that a longtime patient was in the waiting room. She had just switched to that particular insurance carrier and wanted to continue under my care. The insurance company's agreement with us was rigid: It stated that if I took her as a patient, I had to open my practice to all of the plan's patients.
Before my medical assistant could say the patient's name, I stopped her. "Don't tell me!" I said. "I don't want to know because it will eat me up. Explain the situation to her and tell her how sorry I am." Being a dutiful employee, my assistant rolled her eyes, scowled, and left my office.
Four hours later, after I had finished my day, my assistant appeared at my door, looking slightly defiant. "She's still here," she said.
"Who's still here?"
"The young mother of three children whose family you refuse to continue caring for." My assistant had a terrific way of punching my buttons.
I looked at my watch. "After four hours?" I asked, as though she was unaware of how long the patient had waited. "Well, I guess you'd better send her back." I knew this was going to hurt.
The patient walked into my office with eyes red from crying. She apologized for bothering me. I felt terrible.