Who Really Makes Your Health Care Decisions?

one are the days where the patient-doctor relationship was just between the patient and the doctor.  Health care in America involves insurance companies, hospital systems, and pharmaceutical companies all having a say in virtually all decisions made by your doctor about your health.  The VAST majority of physicians truly have your best interests in mind, but they are bound by the constraints our system imposes upon them.  Most patients don’t realize how deep this influence runs and how much it can affect the health care decisions made for you..

Outside Influences

Let’s look at a few examples. Dr. X is your physician who works for a local medical group BigMed, and you have health insurance through ExpenseCare.

• You meet with your physician, Dr. X, and Dr. X wants to prescribe a medication for you.  ExpenseCare however refuses to cover it and will only cover an alternative medication.  Don’t be fooled that this will be as effective, chances are it is an older less expensive medication.  Your insurance company just made a health care decision for you.
• See above, but this time it’s a test your doctor wants to order for you.  This happens all the time that your doctor recommends a test for your specific health situation, but insurance refuses to cover it, apparently they know you best…

These are perhaps the most obvious examples, let’s dig a little deeper

• Dr. X wants you to see specific neurologist for your chronic migraines since he is the area expert on Botox injections to treat migraines, but he works for a competing medical group.  Your physician doesn’t have complete control over who she refers you to – maybe the neurologist is out of network with ExpenseCare, or BigMed could insist that Dr. X refers within their group. And so you get sent to the in-network neurologist who has no experience with this treatment.  As a result you have to go through further testing, treatments that may not work, and more visits with the neurologist. Your insurance company or medical group just made a health care decision for you.
• You visit Dr. X for a stomach ache that has been going on for a couple weeks.  She wants to spend time with you to delve into the issue, but her company BigMed makes her see 20 patients per day in order to meet a certain production level.  They also require her to spend 5 minutes per chart checking boxes so that ExpenseCare will reimburse them at a higher rate.  Unfortunately Dr. X can only spend 7 minutes with you because of this, and so needs to refer you to a gastroenterologist to figure this issue out.  Family Medicine physicians are fully capable of diagnosing and treating a wide variety of issues when they have the time to care for you, but in this situation Dr. X didn’t have the time.  By the way, who makes more money when you see the medical group’s gastroenterologist?  Your doctor’s medical group just made a health care decision for you.

Taking Back the Doctor Patient Relationship

As long as this system is broken, directly or indirectly, your doctor does not work for you. Your doctor works for the system. And whether they choose to admit or believe it, they have to follow rules that are not always aligned with your health.  Having good health insurance doesn't change this, you may have the greatest insurance plan, but that does not mean you have great health care. You might pay for the cadillac of insurance plans but if your doctor only has 7 minutes with you, and is paid by someone other than you, you are just like everyone else in the system.

As more and more patients and doctors realize they are tired of third parties making decisions for them, more and more patients and doctors will go back to having a direct relationship with each other.  This is how health care used to be, and this is how health care should be.  And this is why I started Pure Family Medicine, to take care of my patients, answer only to my patients, and enable them to take back control of their health care.

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