The elephant in the exam room

A patient of mine called the office requesting treatment for an ear infection over the phone because she could not afford the cost of a visit with her high-deductible insurance plan. Although this may sound routine, these requests are becoming all too frequent in my medical practice.

Increasingly, I find myself in an ethical quandary: I sympathize with the underinsured, yet I do not believe good medicine happens over the phone. It is my responsibility to evaluate a symptom before initiating a course of treatment. That is becoming harder to do if patients cannot afford to be seen for evaluation.

The insurance industry is the elephant in the room sitting between my patients and me. Insurers dictate what can be prescribed, what tests are performed, how much time we spend together, even where prescriptions can be filled.

Due to concerns over being labeled with pre-existing conditions, patients do not disclose their entire medical history to me, sometimes leaving out major issues. Physicians cannot be expected to do their jobs if patients are afraid to tell us their medical histories.

Even more outrageous was a recent Blue Cross letter asking providers to look for discrepancies in patients’ medical histories that might identify those pre-existing conditions—and lead to denial of coverage. The company quickly backpedaled from this proposal due to public outrage. Asking physicians to act as police for the insurance giants is completely inappropriate and insulting.

The current system of health care has led to decreased satisfaction for both patients and providers.

The longer I do this, the more I have come to understand that listening is the most important thing I do as a physician. It is not high-tech or dramatic, but critical to healing.

Of course, this takes time. Unfortunately, this is not what is valued in our current system. Doctors attempting to keep up with the rising costs of business are forced to see more patients, while insurance companies transfer the expense to patients and refuse to increase the payments to practitioners.

Another Medicare pay cut has been postponed until June of this year; if passed, it will severely limit access to providers for many disabled and senior patients.

Although I have been practicing medicine less than a decade, already I am seeing my colleagues leaving the field. The current practice environment has eroded the relationship between physician and patient. Burnout, frustration and endless paperwork are leading many physicians to quit the practice of medicine, while patients have lost faith in the system.

Isn’t it time we kicked the elephant out of the exam room?