Insurance company regulations drive doctor and patients to breaking point

Date published: 2/26/2006

MAYBE IT'S A GOOD THING I wasn't top of my class in medical school. Then I might be even more aggravated by the insurance companies' pre-authorization regulations telling me what I can and can't do--regulations that are liable to push some of our patients over the edge, causing them to go "postal" on us.

Medical school was the hallowed halls of Guy's Hospital in the borough of London Bridge. A somber, ominous place where students were derided by sarcastic attendings and disparaged by fussy matrons in silver buckles, silly hats and starched lace. A place where I lurked in the background and didn't exactly shine, but where I did manage to get a medical degree.

Since then, I have kept up my continuing medical education, sat and passed the Boards every seven years, and developed this outrageous notion that I know a little bit about what I'm doing and how to treat my patients.

Wrong.

Wrong at least in the eyes of the insurance companies, or so it would seem. In this day and age, some insurance company policymaker (or accountant, more likely) decides whether you can have Nexium or Protonix or Pravacid or Aciphex for your ulcer, or whether you have to go spend your own hard-earned money on over-the-counter Prilosec.

Some bean counter reviewer decides if Mr. X's back pain is bad enough that he can get one of those awfully expensive MRI scans. I am gratified and humbled to know that they do at least read my notes. But if they don't think it's necessary--even if I , in my educated wisdom, think it is--well, too bad for the patient.

In the old days, when my great-grandfather was a general practitioner in Ballaratt on the outskirts of Melbourne during the Australian gold rush, he would treat a colorful variety of diseases in the surgery room attached to his house. Or he'd go off for days at a time in his horse and buggy into the bush. He didn't always get paid, or sometimes it was with a chicken or some other kind of barter, but there was no one interposed into that intimate relationship between doctor and patient.

How progress has changed all that.

Date published: 2/26/2006