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Re: Andrea--I hate managed care..(Thanks Dr. Hill)
From: Gina (anonymous@obgyn.net)
Mon, 10 Jan 2000 10:42:07 -0600 (CST)
Hi Dr. Hill,
Thanks for clarifying that issue, it explains why it does feel as if my
doctors are paying out of their own pockets! I don't think HMO's should
be allowed to do that to doctors, or patients!
For example, my PCP sent me to a GI doc because I have bowel troubles,
pain in abdomen and also hep c. When the GI doc scheduled an ERCP to
clean out my bile ducts of scar tissue, my PCP tried having the
procedure cancelled. This was blatant interference with my medical care
and was even a risk to my life since a blocked bile duct can be fatal!
I went ahead with the ERCP against his wishes and am glad I did despite
the complications that arose because cirrhosis was a real threat with my
blocked bile ducts and already compromised liver.
How can a PCP do something like that to a patient?
He has also diagnosed me with fibromyalgia, but didn't do the 18 point
test for it, and wouldn't send me to an expert to be diagnosed. I am
demanding to see a specialist for this diagnose since it is an incurable
condition and I want to be sure it isn't something else going on.
I feel my own PCP is putting my life at risk by refusing me medical
care--which I am entitled to under my insurance!
It is frustrating enough being sick without having an HMO doc adding
more stress to my life.
Gina
At Sun, 9 Jan 2000, D. wrote:
>
>At Sun, 9 Jan 2000, Gina wrote:
>
>Your response to Andrea made me think of a few other points. It is
>possible that doctors in your area function under a capitated plan.
>Under capitation an HMO forces the doctor to accept a "flat fee" for
>each covered life, regardless of how often that person uses the doctor.
>Thus, if someone gets really sick, he or she may indeed cost the primary
>doctor money from his or her pocket. Capitation is *supposed* to work
>by averaging the healthy with the sick, and by encouraging the doctor to
>keep patients healthy. In real life, however, this is a ridiculous
>because regardless of how hard your doctor tries, she or he cannot
>possibly prevent most illnesses. In areas where there are high illnes
>rates, it can easily become so bad that the doctor is left deciding
>"should I refer this nice lady to an expensive specialist, who I will
>have to pay for, or pay my nurses this month?" Obviously I strongly
>disagree with this type of medical care.
>
>With regards to prescriptions, doctors do not get kickbacks for
>prescribing medications. There is no benefit to me when I prescribe
>meds. In fact, writing hundreds of prescriptions a week takes time, so
>it would probably be easier for me if none of my patients needed
>prescriptions! However, HMOs keep close track of Rx utilization, and may
>drop a doctor from their plan if he or she uses the most expensive type
>of medication. Again, this is to motivate the patient and doctor to use
>equally effective but less expensive medications. In real life it often
>puts the doctor and patient at odds. The patient is standing in front
>of the doctor, not a nameless, faceless HMO executive, so she is more
>apt to become angry at her doctor when she wants a particular
>medication.
>
>There are a lot of problems with HMOs, although some are clearly better
>than others. Many people do not realize that they have the potential to
>force change. Write a formal complaint to your human resources
>department. Write your congressperson. For severe problems, contact
>the local media. In the meantime, good luck with everything.
>
>As a final note to Andrea, I agree that you should have been contacted
>by the doctor's office. It is a very busy time of year with the flu
>outbreak, but you have experienced a long delay. Downsizing has hurt
>the customer service at most doctor's offices, but this seems excessive.
>Best wishes,
>
>--
>David Ashley Hill, MD
>Associate Director
>Department of Obstetrics and Gynecology
>Florida Hospital Family Practice Residency
>http://home.mpinet.net/dahmd
>
>My apologies, but due to time constraints I am unable to answer private e-mails.
>
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