Waging Health Battles by Fax

I must admit that I am still baffled how U.S. Healthcare has evolved to the point that highly trained medical professionals now spend a tremendous amount of time in doing the kind of tasks described below. This is completely different from my experiences overseas, in which the patient's health is actually the focus of attention, and I can spend 95% of my time helping my patients in terms of direct medical or surgical care.

There is a battle that goes on behind the walls of the family doctor's office every day. We try to get the medications and tests and referrals that our patients need while also seeing patients who require care. The insurance companies don't mind me taking heat from the patients when they don't get the medication I recommend. And they don't have to worry about the liability that I, as a doctor, face for using cheaper drugs that may put the patient at higher risk of complications.

They want me to incur the overhead and frustration that comes with trying to prove to a non-doctor that I know my patient and what I'm talking about. They want to cut costs, and they don't really care about how it affects my patients or my practice. If they make the process hard enough, they hope I'll just give up. There is even a term in the managed care literature for that kind of deterrence: the "sentinel effect."

A 2001 study showed that a doctor seeing 22 patients a day, averaged one insurance hassle lasting for every four or five patients. More than 40% of hassles were reported as interfering with quality of care, the doctor-patient relationship, or both.

I think the hassle factor has doubled in my practice since 2001. Most patients are minimally aware of the battles we fight daily on their behalf. They wonder why the office gets bogged down or why doctors or office staff don't call back.