1. Health
Trisha Torrey

Patients Squeezed Out While Trust Continues to Erode

By April 20, 2012

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Two pieces of information, including one "now what am I going to do?" email this week offer continuing evidence of the erosion of the patient-doctor relationship - a situation that we patients must protect ourselves from.

The first piece of evidence: an article in Newsweek Magazine called The Doctor Will See You - If You're Quick, by Shannon Brownlee (who is the author of Overtreated) which cites research showing that doctors are spending less and less time with their patients, and that patients are being hurt both by medical harm (the less time spent, the more mistakes are made) and in their wallets. I call it "Drive by Doctoring."

Of note: doctors who used to see 1800 patients in a year are now seeing an average of 2,300 patients per year (called the patient panel). That means that, on average, that doctor is spending 22% LESS time with each patient. Further, research shows that "critical information" is delivered to patients in an average of 1.3 MINUTES. That's MINUTES.

Now - this is important to understand.... doctors are doing this because it's the only way they can stay in business. This is not a personal snub of their patients. Given the choice they would most definitely spend more time with us.

The problem is that insurers are paying them less and less - and in order to keep the lights on, and keep their billing staff paid (what kind of a screwed up system is THAT?) they have see more patients, and limit the time they spend with each.

Here's the big problem for us patients: If the doctor doesn't spend enough time with us, he or she goes home at the end of the day, eats dinner, plays with their kids, reads a good book, watches some TV, and goes to bed. When we patients don't get what we need from our doctors, then we get sicker and die.

So you tell me - who has the biggest stake in stepping forward to fix the system? We patients, of course. If you are sick or debilitated today, then the only person you can take care of today is YOU. I'm not asking you to take on the entire healthcare system. I'm suggesting that you take steps to help yourself.

The second piece of evidence: an email from Mary (not her real name) that described a scenario that should make all of our toenails curl. I suspect it's going on every day, and most patients don't realize what is really happening.

Mary was dismissed - fired! - by her doctor. I've written before about why doctors dismiss patients, and there is no question that sometimes patients deserve to be fired. However, in this case I believe the reasons were manufactured to remove Mary as a patient, may be fraud-related, and now Mary and her family will pay the price.

Mary needed new insurance, and in the application process, the insurer came back and asked her why she had been in the ER in 2010. The question is important, because if the insurer thinks there is a medical problem, they are going to raise her premiums exponentially. They can't, by law, simply turn her down for a pre-existing condition. So they just make it more expensive.

The thing is - Mary was never in the ER in 2010. Her last ER visit was in 2005, before she had ever seen that doctor and outside the "How many ER visits in the past 5 years?" question that the insurance application asked for. So she asked her doctor for copies of her records so she could verify to the insurer that she had not been in the ER in 2010.

What she found astounded her. A variety of errors in the records and notes making claims about Mary's health that just were not true. So she decided she needed to correct her medical records - as she should - and within the next few days, not only did the doctor refuse to amend the records, but the doctor fired Mary as her patient.

Here's my take on this scenario based on what I've just explained, plus other information Mary shared with me:

First - the doctor has made claims in Mary's records that would allow for billing at higher rates, called "upcoding" - and that's why I suspect fraud. So, for Mary to want to change the records could mean that later, if there is fraud taking place, then other records of that doctors could be called into question, too.

Second - if Mary is currently uninsured, then that doctor doesn't want Mary as a patient. So now the doctor is caught between a rock and a hard place - if she keeps Mary as a patient, and she is committing fraud, then bigger problems will erupt down the road. Further, many doctors are looking for ways to dismiss their uninsured patients because, of course, they are worried about getting paid. With two whammies going against her, Mary was dismissed.

The "reason" the doctor gave Mary for the dismissal was that it was clear that Mary didn't trust her anymore. Well - I guess not! But it all seems quite fishy, and smelly, and it's definitely a no-win situation.

I've explained to Mary that she is far better off with a new doctor anyway. Clearly this doctor can't be trusted. If she is playing with Mary's records for the doctor's own advantage, then Mary needs to move on and find another doctor.

What are the lessons for the rest of us?

First - to realize that all the negative money-focused forces continue to squeeze US - and our health and wallets. That means taking the steps to learn more about getting the most from the healthcare system for yourself and your loved ones is imperative. Because if you don't, YOU will be the one who gets sicker or dies, sooner, rather than later.

Second - to talk about this very point with your friends and loved ones. To explain what you are learning. To spread the gospel about the need to either advocate for yourself, or to find someone who will advocate for you. Because if they don't, THEY will be the ones who get sicker or die, sooner, rather than later.

Sadly, the entire system is only getting worse and more confusing. Sorry to say - there is no good news on that front.

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