When I speak to patients about sticking up for themselves, I often suggest they consider what ends they would go to in order to stick up for their own children. That's the level of regard they should give to sticking up for themselves.
Diane Engelman is the perfect example of the parent I'm talking about. You can read her story at e-patients.net -- the story of going to bat for her daughter, Hilary, who needed a heart valve replaced. Hilary's treatment was stonewalled by her HMO and its surgeons -- for even the toughest of us, it seemed almost impossible that Hillary would ever get the treatment she needed.
But as my friend and colleague, ePatient Dave DeBronkart describes the story,
In this case a large health plan was out-thought, outresearched and outmaneuvered by one of the most potent e-patient subtypes: the "Mama Lion."
Diane and Hilary's story is unusual only in that it ended up having a good outcome. For too many others, that just isn't the case.
While most are appalled at the dealings Diane had with her insurer, Kaiser, and Kaiser's cardiac surgeons, I actually see something very disturbing in this story from an entirely different angle.
I see a new category of medical mistake being made by these surgeons - that is, the mistake of selling out. And people dying because of that sell-out.
When you read Diane and Hilary's story, you'll learn that Hilary's heart problems progressed for years, and eventually led to the need for some type of surgical intervention. The questions were whether Hilary would need her heart valve replaced, or whether there was a way to repair it.
But Kaiser's cardiac surgeons just kept putting her off. Diane did enough homework - diligent, deep and doubtless - to know that Hilary needed surgery and that a less invasive form was entirely possible. Yet, she was stonewalled and stonewalled agein by the surgeons at Kaiser.
If we step away from the actual facts of the story, we can surmise the reasons for the stonewalling. Those reasons are all money and ego-related.
Kaiser didn't want to pay for the surgery. Why? Two reasons: first, because it's long, time-intensive and for Kaiser's own cardiac surgeons, the results were not good. They risked either the cost of the surgery or the cost of the ensuing lawsuit because none of their surgeons were skilled enough to do it.
Kaiser didn't want to pay for an off-site, out of state surgeon to do it. It would be far more expensive than paying for their own (even though no one on their own staff could do it successfully). And even worse:
Hilary might survive. Yes, that's right. If she died, then they wouldn't have to keep paying for her care. But with survival, she might then have to be supported with drugs and perhaps future problems for as long as she lived and was still a Kaiser patient. (Or maybe not -- but they had no idea how successful or unsuccessful it might be. Turns out it was very successful -- but Kaiser didn't know that would be the case.) Since Hilary lives in California, that could possibly mean for the rest of her life. They didn't want that cost burden.
But the reasons that are most disturbing to me are these: that those surgeons would rather watch a young woman die than 1. grow past their own stubborn egos and 2. contradict their fellow surgeon friends and 3. go up against their employer to advocate for Hilary.
They sold out.
I suggest, then, that we add to the list of Never Events - those medical errors that are so grave that they should never happen. That error would be Selling Out.
Do you know of victims of this type of error? Have you been one yourself? Have you had to fight like Diane did for your medical needs or the needs of your child? Have you watched doctors simply agree with each other because they didn't want to contradict their doctor-friends?
There can be little more frustrating than this kind of scenario. Please share your story with us - you'll be helping other patients learn how to fight to get the care they need.
Share Your Story: Has Your Doctor Sold Out?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Learn more or join the conversation!
NEWSLETTER | FORUM | BIO | TWITTER | FACEBOOK
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Photo © iStockPhoto.com
Trisha;
I don’t think this falls into the category of a “medical error.” We usually think of that term as someone trying to do the right thing but failing, for either heuristic human reaons (lapses), system failures or knowledge deficiencies. This to me seems what is called a “violation” – e.g. Kaiser knew better but deliberately circumvented the standard of care.
I am sorry but I cannot excuse this under the term “error.” As I commented on e-patients.net, I think it borders on, if not represents, malpractice.
The problem here seems to be with Kaiser, the entity, not the doctors. If individual doctors did not feel they were qualified to perform the surgery, they were ethical in refusing to do it – both to the employer and to the patient. If the HMO didn’t want to pay – to staff their department with physicians who possess these rare skills or the right knowledge, to allow specialty care by non-Kaiser doctors, or to support this patient for life – that isn’t the fault of the doctors. (And I’m not a doctor!)
Trish, the subject matter of this article disturbs me as much as it should–I believe–anyone concerned about the state of American healthcare. You’ve uncovered one of the pervasive problems with HMOs.
I also, however, believe that “selling out” misconstrues the problem. Do you really believe anyone at Kaiser really wanted to provide a poor solution just so that they could keep the money in-house? If you look over their responses, I think you’ll find that the problems were a bit more complex than that–still bad, but let’s call a spade a spade.
First, the cardiologists at Kaiser, like most of the cardiologists I’ve met around the world, are quite full of themselves. They don’t want to hear that anyone else can “do it better”–no matter what “it” might be. They think they can do anything, and they hate to hear otherwise.
Second, every doctor I’ve ever dealt with was perfectly willing to allow a patient to get a second opinion. The real evil of HMOs is that they’re insular. Doctors at Kaiser have grown accustomed to the idea (the really asinine idea) that “second opinion” means the opinion of someone in their own little click. They all know each what the other will say because they discuss this sort of thing over coffee all the time. HMOs create a system that excludes the growth that more open medical practices obtain through continuous intermingling with other practices.
So, “selling out” is a wrong-headed condemnation of the doctors. They deserve condemnation but not for that. What they’ve done is become insular and complacent. They’ve become intellectually lazy. They’re like a bunch of penned up lions. They’re used to having everything fed to them, so they become mentally fat and sluggish.
In any case, thanks for keeping the fire to their feet. They really need it.