One thing I have noticed since I have been on the beach is that we don’t trust doctors. I reluctantly have come to that conclusion based upon the experiences I have in helping family members as well as myself navigate our healthcare system.
You would think I would have realized that fact a long time ago but things look differently when you are caught up in the day-to-day work of healthcare. You sometimes see the needs of everyone but the patient.
We (whoever “we” is) have constructed an obstacle course which doctors must traverse in order that their professional opinion meets their patients’ needs. Patients must wait for prior authorizations to be granted by health plans and other entities before a doctor’s advice can be followed. There is a whole bureaucracy both within and without the organization devoted to second guessing the patient’s doctor.
My experience is that most requests for prior authorization are granted and those that are not are usually approved after further consideration. What a waste of time and money.
The justification for this process of second guessing has both clinical and financial components. There is concern that needless tests or procedures may lead to clinically dubious results. Too many false positives lead to potentially harmful interventions.
While I recognize the clinical argument for oversight of doctors’ decisions, the cynic in me thinks the bigger motivation for not trusting doctors is the financial component. A test not done is a test not billed. Think of the money saved if each doctor has one MRI order a month denied. Anyone who thinks the clinical argument is the real reason for second guessing physicians’ decisions is displaying a naivety that needs a review in itself.
The problem with this lack of trust in decision making by doctors is that it carries its own risk of leading to poor clinical results and also creates an expensive structure devoted to second guessing. Back when I was in the office and not on the beach, I watched in dismay as we built a staff to manage the interface between doctors, patients and health plans. This expense became significant.
I used to joke that it might make more sense just to take the risk that one or two doctors might order tests excessively in order to avoid the expense of overseeing the decisions of all the rest of our medical group. Now I am not so sure that is a joke.
It may be time for us to begin trusting our doctors again. If there are outlier doctors in terms of inappropriate use of resources, it would be better to deal with them after the fact. It might mean those doctors and their decisions would be subject for a period of time to oversight while the remaining medical group members would be able to use their professional judgment without second guessing. Why punish all doctors and their patients for the sins of a relatively few?
We have the means now through the electronic medical record to gather relevant data and look for the outliers. The money saved could be substantial if we once again began trusting our doctors enough and reducing the nanny bureaucracy. Patient and physician satisfaction would certainly increase and one needless layer of cost would be gone.