- It makes it more difficult to make them happy.
- Patients get annoyed when their doctors cannot get testing done. They think that it is stemming from us. They don’t see it as a systemic problem.
- Now almost anything we do we have to really think about the cost benefit ratio to the patients. Will the insurance company pay? If not, can the patient afford it? Will the patient be physically harmed if they don’t get it?
- Managed care was the first wedge between the doctor and the patient. This was brought about by the fact that some doctors participated and some did not. If your physician participated, your patient had a small co-pay and it became evident that a small co-pay was more important than a long term established doctor patient relationship. It became obvious immediately. The relationship has blown up in the face of those who wanted it destroyed. It took the leverage away from physicians. The problem is that it also increased health care costs. As I said earlier, when you don’t have a doctor patient relationship you don’t have compliance and then costs go up. They go up because patients who are not compliant have worse outcomes, and also when the doctor and the patient do not have relationship, the physician is more likely to over test to over test to reduce the chance of malpractice. Most malpractice is a result of a poor relationship with the doctor and the patient.
- They understand that I want to prescribe drug A but I cannot do it. They do not take it as a personal thing on me.
- On the financial and insurance end. Some plans require fights to get tests and specialists. This all drives a wedge in between me and my patient and I resent it.
- It affects the relationship. As much as you try, you have to spend less time with the patients. Have to squeeze more people in. When you do have too many people you are seeing you cannot keep up with them all.
- It probably affects me less because I don’t let it enter the discussion. I examine them blind to their carrier. They all get the same level of care. The difference is in the discretionary things where people have to be able to afford to purchase it. Or if they can’t be referred to certain people because there are not in their plans.
- The government and insurance are coming between the relationship. It is a doctor payer relationship. They are trying to save money but are being paid huge amounts of money. If the government would work on that and limit that stuff more. The insurance intervention is becoming more and more difficult. You used to be able to write for any drug you wanted. Then a non preferred drug would cost the patient more this year we are not going to pay for it. You can fill out an authorization but we are not going to pay it. So you are paying full freight. Some insurance companies are telling me which generic to cover. A lot of people work for big companies and they have not yet felt the pinch of Obamacare. Talk to people with left leaning and they don’t get it.
- Puts stress on it. But most patients realize that if you are the type of doctor who goes after what you need, less stress. They worry about the doctor who won’t do the test or get the right meds, they worry about that. If you do the exceptions and paperwork, they know you are trying.
- Less time to interact with the patients.
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