Saturday, August 16, 2014

First Blogpost! Thoughts from my Family Medicine Preceptorship

"Medicus enim nihil aluid est quam animi consolatio" (A doctor is nothing more than consoalation for the spirit) - G. Petronius Arbiter


Forget non-compliant patients, clunky electronic health records that are not compatible with one another, or WebMD and other 'eMedicine' sites convincing patients that a stubbed toe is actually brain cancer. Nope, it is insurance companies and pharmacies that take the cake as the most stressful parts of primary care - for both provider and patient.

A mandatory peer to peer review for approval of a diagnosed diabetic's insulin supplies...really? Meanwhile, patients are without means to give themselves necessary insulin.

A prior authorization for a previously approved (and over the counter) medicine that was split into two pills, each of half strength from a previous dosage to avoid side effects, because splitting the same dose into two apparently makes the med suddenly "exceed the max daily dose?" Despite someone's inability to do fourth-grade math (fractions/decimals are just too hard for these people), the dose given, "split or together," was not even close to the max daily dose. And now the patient is without meds.

One pharmacy charging $200/mo for a particular med on insurance whereas the next charges $25/mo cash pay? And patients aren't easily educated about this price gouging because pharmacies purposely hide this information from provider and patient, and it widely varies from insurance plan to insurance plan and pharmacy to pharmacy.

Insurance requiring patients to medically fail two generic meds just to cover a specific brand name med with stronger medical literature to support its efficacy over the generics? It's but a sick joke as patients' lab values are uncontrolled for 6mos minimum just to prove medical failure. Unacceptable!

Decisions NOT to cover pap smears and other routine preventative medicine procedures past a certain age when, as the life expectancy continues to go, so too does the age of finding new cancers and other pathologies? Why does this country's healthcare system continue to tell our senior citizens that coverage is ONLY for the young?

This is but a sampling of the shenanigans I saw this summer. 

A lot is terribly wrong with healthcare in this country, but if I have learned anything from working in primary care these past few months, it's that people without medical licensing or knowledge are making many extremely impactful health care decisions and regulations for patients behind the scenes - just to make a buck and despite the patient's wellbeing. I knew it all existed to some degree...but now seeing it firsthand, I can say the extent of their oversight is absolutely outrageous and unbelievable. No wonder there is a shortage of PCPs in this country...who would find satisfaction in dealing with these issues and regulations every single day?! (Well, me, but that's beside the point). In the end, these companies are preventing patients from adequately managing their health conditions and straining their wallets...not to mention wasting both the physician's and patient's valuable time with these people and companies pretending to play "Doctor," instead of allowing licensed healthcare professionals to practice medicine.

As a budding geriatrician, I worry for the future of the baby boomers I will one day treat, because Medicare and Medicaid are some of the worst offenders. Not to mention, they are among the patients perhaps most in need of good coverage to manage a multitude of chronic conditions, which tend to increase in number with age.

But, it has been a blessing to learn the tricks of the trade from my preceptors on how to fight against these restrictions, demand nothing short of excellent care for patients, and give patients the best and most affordable treatments possible, despite these companies' and organizations' barrage of medically harmful obstacles. In a weird way, these barriers only have made me MORE excited to someday practice primary care and MORE passionate about the geriatric population's healthcare needs. 

Bring it on, insurance companies and Big Pharma, because I am a fighter!!