I also refuse to play the game. And, I am becoming increasingly more vocal with patients about their insurance company's intrusion into their health care. I had a patient call in today complaining of cold symptoms. He wanted me to call in an antibiotic because he was "afraid it would go into his lungs and cause pneumonia". I refused to call anything in and had my staff tell him if he is sick enough to warrant an antibiotic, he is sick enough to warrant a diagnosis, which means a visit to his physician. He got mad and told the staff he thought it was a bunch of crap that he should have to come in the office for a "cold". He told them "all she wants is to rack up another office charge."
Well, that did it. I got on the phone and explained to him that his insurnace company is one of the very worst about mailing me crap about apparent patient non-compliance with medicines, junk about whether or not I was aware of potential drug interactions (such as ASA and Plavix in a recent coronary artery stent patient..."Are you certain you want this patient on these medicines?") and burdening me and my staff with requests for office notes to assess whether I am managing THEIR patients appropriately. I told him I was not about to incur the wrath of his insurance company for prescribing inappropriately nor was I going to risk being put in a court room just because I failed to properly see and evaluate a patient prior to the prescribing of potentially dangerous medicines. By the time I was finished ranting, he was apologizing profusely. I told him it sounded like a common cold, to treat himself conservatively and if he failed to improve after 7 days or worsened at any time then he could make an appointment and I would then evaluate the need for antibiotics. He said he was not aware of the serious issues I had and thanked me for my time. Once again, we docs MUST make the patients understand why we do the things we do and more and more it is because of insurance companies, the federal government or the fear of legal retribution.
Leslie
