February 23, 2004
in response to Clueless in the Land of Managed Care, by Anonymous Physician (January 6, 1997)
Kudos to the anonymous author and physician who braves the winds of "managed" care. As an RN who has been around since before the inception of managed care, I also have seen the managed care system disregard the patient's best interests for the sake of the greenback many, many times.
This is not to say that controls are a bad thing; without them, we would see flagrant abuse. Somewhere however, there should be a happy meeting place where the patient receives uncompromised care, and a physician or practitioner can go home in the evening and feel good about the job they have done. Many times managed care seems to "stiff" the physician or practitioner, the referral institution, and certainly the patient. Managed care is badly in need of restructuring so that this does not occur.
In theory, the managed care concept is a good one; but those bureaucrats our authoring doctor mentioned need to be removed from the equation. It is impossible to expect physicians and practitioners to make medical determinations of any value with no knowledge of the patient and their condition at the time of the call for approval. For instance, doctors who serve in on-call situations to cover for their own physician groups, as well as to meet the on-call requirements of their hospital affiliations in Emergency Rooms, Labor and Delivery and the like, are commonly asked to make treatment decisions for patients they have never heard of -let alone seen. The nature of this practice instills an inordinate amount of risk to all parties. Managed care as we know it, by its very nature, intensifies this. Sheesh! You might as well give practitioners a crystal ball and expect them to make decisions based on the use of that ball. Good job, Dr. Anonymous! It must be hard to practice with those boxing gloves on, but you keep punching!
L. Jackson, RN