I have to admit it.  I'm feeling guilty.

In my last post I admitted that I had thrown in the towel.  Rather than go to bat again for my patient whose medication had been denied by his new insurance company, I gave in and prescribed an alternative that might not work as well.

Well, today the guilt got me going so I re-read the two page denial letter.  Again I found the words explaining the reasons for the denial, two of which amounted to advocating for unscientific medicine, even malpractice.  And I found the additional sentence, buried about two thirds of the way down page two, which said that I could call the "800" number on the page to talk with the doctor who had reviewed the case and denied my prescription request.

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Every day I practice medicine I get a new story.

 

Today I attended a "pod group" meeting over lunch.  Billed as meetings of primary care providers hosted by our local medical group to allow us to get together and share items of importance to our practice, the meetings instead have degenerated into coaching sessions about how to "code" patient encounters in order to maximize income, for the medical group and, secondarily, for us.

 

The care provided by family practitioners, pediatricians, and general internists--primary care providers-- is known to be the most cost effective in medicine.  We know our patients.  We understand where they are coming from.  We can use this knowledge to tell, often, when a belly ache is a sign of serious disease, when a serious investigation is needed, or when reassurance and a little "tincture of time" is all that is needed.

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I arrived this morning in the office at 8:50 a.m. to find Glenda, my office manager, buried in charts.  She had been there since 6:30, simultaneously arranging referrals that had been requested the day before, making sure that we had properly completed the detailed forms required by the Child Health and Disability Prevention Program that helps pay for the preventive care provided to some of our poorer patients, and listening to the voice mail from pharmacies to get the medication refill requests in order for me before the day begins in earnest. 

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