Monday, November 17, 2008

Caught in the middle....

The specialists are crying "Robin Hood" and the PCP's are whining undercompensation. The hospitalists are gloating. A feud to rival the Hatfield's and McCoy's is a-brewin'. And the patient (that would be me)? Oh, I'm caught in the middle of all this.

So, do I take cover, take a side, or run for the hills?

I commented over on Dr. Wes' blog:
Hey, Dr. Wes... you know I deal with this as a patient where I live. I see my PCP who doesn't have time to do all that needs done, so I'm farmed out (I believe the word is "dumped" in medical-ese)to a specialist or specialistS. That specialist only deals with his/her area of expertise, so I'm farmed out again (dumped) to another specialist for another symptom, etc..etc...

Well, no one ties together all the symptoms. I end up in the ED or hospital and I get either a wonderful ED doctor or hospitalist who does just what you said above, and nobody has a clue what is really wrong. I have great insurance, but I still pay hundreds of dollars (or thousands, depending) with co-pays and the like. Not to mention I pay for my insurance.

What do I do? I go see someone who gives a damn on the other side of the continent. He doesn't take insurance. I pay out-of-pocket. He does give me a bill to submit to insurance which is reimbursed at a percentage. But I get great overall care. I can test at home. He and his [very small] office [staff] help coordinate all that but I'm the middle (wo)man. The problem with that? I can't afford the travel [very often].

My point: It's bigger than shifting funds. It's bigger than paychecks and "Robin Hood" economics. It's my life. I don't mind paying what is due. I just want something from it. I hate piecemeal. I want a doctor who can put all the puzzle pieces together and then figures out what needs done.

What happens with patients like me? Dr. Rob points out what happened to one patient in Overmedication. We get fragmented treatment with the variety of specialists, hospitalists, and ED doctors. Our PCP's don't have time to figure all that out without a proactive patient (or caregiver) pointing it out.

So....what's the answer? I don't pretend to know. I just know I'm willing to do my part to make it better.

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