My Pet Peeves with Our Healthcare System

May 20, 2011

Can insurance companies please give us a step-wise plan for writing certain prescriptions? That’s just one of my pet peeves as a physician. I have many more.

As I pondered the topic for this week's blog posting, I thought it would be helpful to share some of my frustrations with our present healthcare system. While I do think that some aspects of our healthcare system do need to be changed and improved... well I will keep the other comments from that last sentence to myself.

I do not think that physicians are all-knowing people. We see our patients and after performing the appropriate history and physical examination, we formulate the appropriate assessment of their problems and formulate a plan that will best suit their needs. I am very mindful of the cost of healthcare, be it prescriptions, diagnostic studies, trips to the office, etc. However, I do feel that I am a good steward of my patients' healthcare dollars. Any patient that is treated by me gets the exact same treatment that I would expect any of my family members to receive from another physician. I have held myself to this standard from day one in my career. I do realize that healthcare is expensive, and I do think that certain elements of our healthcare system can be improved without the all-knowing influence of our federal government.

My biggest pet peeve: Can insurance companies please give us a step-wise plan for writing certain prescriptions? My patient that has reflux symptoms will always be treated with a low cost generic medication, in addition to giving them advice for lifestyle changes that can improve their symptoms. When I do choose to prescribe a PPI, why is it that my staff must always call for a prior authorization? This is a step that places an obstacle for my patients in getting the treatment they need and it also places extra work on my already busy office staff. I wish the payers would give us some instructions for such prescriptions. Certainly I document when treatments fail, when the patient fails to lose weight, stop smoking, decrease caffeine intake, etc, etc. Since I document this precisely, why must I still call for the approval?

Next pet peeve: I feel that I order a very small percentage of diagnostic studies. Wasn't it Osler that once said, "...if after taking an appropriate history and physical examination from your patient, if you do not know the cause for their problem, please repeat the history and physical." This recommendation is followed by me and after more than 100 years, it does still apply. However, when repeating the evaluation does not provide the appropriate answer and when the ordering of a diagnostic test is written, we still must call for the approval from the payer and sometimes I even must speak to a physician reviewer as well. I can tell you that every time I speak to a physician reviewer and explain my thought process (which, of course, is documented), the diagnostic test is always approved. The extra time spent here is absolute nonsense and it does nothing but delay the treatment needed for my patients.

Next pet peeve: Why is it that the cost of my own healthcare insurance and the cost of my patients' premiums increasing at an exponential rate each year? Yes, we all get older as each year passes and I can understand a certain small increase from year to year. However, the increase in premiums does not correspond with the payment received for office visits, prescription coverage, and payments to hospitals. If anything the payment changes stay flat each year or if an increase is observed, it is on the order of less than one percent.

I understand that healthcare is expensive. However, I also feel that the payers and the federal government must also understand that not every decision in medicine can be driven by the expense outcome. Is there a perfect answer out there? Perhaps. Does the entire delivery system need to be rebuilt from the ground up? Of course not. I am sure that the final answer will be provided by persons much more intelligent than myself. Until that time comes, all providers of healthcare need to communicate with each other routinely in order to share best practices and treatment protocols that lead to better and more efficient patient care.

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