So Long, Farewell, Insurance Changed Goodbye...

“Thank You” read the title of the message. As gratitude tends to make me happy, I opened the message with the expectation of good news. It wasn’t. A family that has been under my care for over 20 years, whose children I delivered, was leaving my practice for good. Their company insurance options had changed and staying with me would cost them over $2000 a year. With sadness and reluctance they signed up with Kaiser and send me the email thanking me for the care I.

A few days later a patient came in with a similar story. She was changing to a different HMO. Although I am affiliated with the hospital to which she was going to be assigned, the hospital contract with the insurance blocks her from seeing me. If she wants coverage, she has to enroll with them and see a new doctor.

This is the health system our society has chosen. Large hospital systems are committed to capturing every dollar they can and to do that they are affiliating as much as possible with medical groups they own or subsidize. These groups employ doctors who are contractually obligated to send every patient they see to that one hospital for any needed test or x-ray, maximizing revenue. These hospitals then sign exclusive contracts (at discounted rates) with large employers, contracts that give patients no choice but to sign up with them. The end result is that long term physician-patient relationships are cast aside.

Complaining is futile. Under the current system, patients have almost no say when it comes to choosing their coverage. These decisions are made by VP’s of Human Resources who negotiate with providers for the lowest possible price. No consideration is given to the savings associated with long-term relationships, of the value that comes from a doctor who knows his patients well.

This seems terrible at first, but the reality is that many doctors don’t know their patients well. Some hardly at all. This because when physicians rush through annual visits and refer all sick visits to urgent care there is not much of a chance for relationships to develop. When after hours calls are handled by call centers, emails are answered by other providers, and it can take weeks to schedule routine visits, strong relationships seldom develop. In such a world the value of a personal physician is minimized.

I wish I could change the system, but past system-changing efforts have proven to be disastrous failures. In conversation after conversation I have learned that the majority of Primary Care Providers are more interested in going home on time than they are in building relationships. When given the choice of staying a few minutes late or punting care to someone else, most choose the minutes and go home. My exhortations that there is joy in relationships are routinely ignored and met with disbelief.

Electronic records have made things worse by limiting the amount of time physicians can spend talking with their patients. It seems that doctors spending more time clicking the mouse than they do listening to their patients. In addition, many doctors don’t type well, and most struggle to use electronic records efficiently. I know many doctors who routinely spend 2-3 hours at home each night finishing up their work for the day. Such overworked physicians cannot see a reasonable way to invest more time in getting to know the patients they serve. Most have given up on ever having the time to build relationships.

I can’t control them, but I have decided to not give up. I cannot control what happens in the future but I can control how I spend my time today. I haven’t given up on loving and serving the patients God brings to me. Every day brings the joy of relationship, the knowledge that I have made a difference in someone’s life.

Even if that means shedding a few tears when we say goodbye.

Bart

 PS- If your insurance had changed, there may still be a way to continue seeing your doctor. If you have changed to a high deductible PPO, you will likely be paying cash for office visits anyway. Your doctor might be willing to see you at a discounted cash price, and your out of pocket costs may be the same as if you saw an in-network provider!

Cheap Faith

It happened again this week, more than once. Single patients told me about their strong commitments to their faith and then followed their professions with requests for Viagra prescriptions. As is almost always the case their requests were made unaware of the contradictions they represented. I am always tempted to ask, “How is it that a devout single man such as yourself finds himself in need of Viagra?”

I see such inconsistencies almost every week. I see “Christians” who abuse alcohol, cohabitate, work under the table to avoid taxes, or get divorced for no other reason than “I’m unhappy!”. It seems that our culture has embraced a new kind of Christianity, a kind that does not cost a person anything.

I was discussing this phenomenon this week with some friends and one of my favorite Bible stories came to mind. It can be found in 2 Samuel 24. In the passage King David is following God’s instruction to raise an altar and offer a sacrifice at a specific location, the place were a man named Araunah threshed his wheat. One can only imagine the surprise when Araunah looked up from his labors to see King David and his entourage approaching!

Upon hearing of David’s mission, Araunah responded as a faithful servant should. Araunah offered to give David his own oxen for the sacrifice, as well as their yokes for the firewood. David’s response is priceless, “No! I insist on paying you for it. I will not offer burnt offerings to the Lord my God that cost me nothing.” David understood there was no such thing as a free sacrifice.

It seems that too many nowadays are into offering things to the Lord that do not cost anything. It is as if some are saying, “Faithfulness? Fidelity? Moral Purity? No way, God! Those things are costly. How about I give you a few Sunday mornings a month and put a few bucks in the plate every once in a while?”

The truth is that God does not negotiate the terms of our obedience. As Jesus said, “Whoever wants to be my disciple must deny himself, take up his cross and follow me.” Self-denial is not optional in following Christ. It is mandatory. It is essential.

While many professed Christians do not seem to understand this truth, I think most non-Christians do. They understand that the genuineness of our faith is measured by the consistency our actions, not by the passion of our words. When they see people living lives that are the same as everyone else, they appropriately conclude that for many church is little more than a religious social club.

I want to be better. I want to follow God with my whole heart, whatever the cost. After over 40 years of pursuing my faith I have learned that this is indeed an expensive proposition. Hardly a day goes by that I am not saying “No” to something I initially want to do. I am constantly challenging myself to be patient and kind, to bite my tongue, or dismiss a malicious thought. It can be exasperating. I have such a long way to go and so much work to do.

There is a tremendous amount of energy I need to invest in denying myself and following God. True faith is indeed costly.

It is costly, but I have also come to understand that in the long-term, the return on investment is AMAZING.

Bart

Late to a Funeral

Fifteen minutes late, I quietly slid into the back pew. The service was well under way and the pastor was over halfway through his reading of my deceased patient’s biography. “Oh well”, I thought, “at least I made it!”

I almost didn’t. The funeral was at 2:30 and I had spent the first part of the day at Disneyland with my family. Lisa and I had been invited to share the Saturday with my son and his family. There was no way I was going to miss an opportunity to be with my grandson. As Charlie is only 2, I figured he wouldn’t last that long and that the 2:30 funeral start time would not be a problem. I took my suit along in the car thinking that we would be done in plenty of time for me to make it.

I was mistaken. Charlie had greater than expected endurance and he did not run out of gas until after 2. When we exited the bus in the parking lot and headed for our car, it was 2:28. I wondered if I should skip the service, thinking that it would be disrespectful to be so late. I also wondered if it would matter to the family whether or not I was there at all.

Something inside made me feel like I needed to go. I checked google maps and saw that it was only an eleven-minute drive from the Toy Story lot to the funeral home. “I’ll drive so you can change in the car,” Lisa offered, and my decision was made. I slipped into the passenger seat, grabbed my clothes from the back seat and transformed into a quick-change artist. My clothes were on and my tie was tied by the time we arrived at the funeral chapel. I found the entrance, stopped to sign my name at the bottom of the guest book, and found my seat.

As is so often the case, I learned many new things about my patient from the service. I had only known him as a debilitated man with heart failure and diabetes. He was so much more. Listening to his life story and watching the slideshow I learned of a muscular man who loved to hunt and fish and enjoy the outdoors. He had built a business and a family, and he loved his grandchildren.

When the service concluded, we were excused by rows, starting from the back. The family waited up front as we all lined up to express our condolences. I was fourth in line and watched as the wife, also my patient, greeted the other mourners. The hugs exchanged were brief, as were the words shared. Until she saw me.

He eyes widened as I approached, then filled with tears. “You came!”

Her composure broke as she reached out her arms and embraced me. She held me tight, her head on my shoulder, and began to cry. Up until seeing me, she had been in total control. I returned her embrace, all the while wondering why it was me that had brought such a response.

After a moment, she gathered herself and relaxed her embrace. She took me by the hand and said, “You have to meet my kids.”

Her adult children were standing behind her. She pulled me to them saying, “This is Dr. Barrett.” Their faces softened in recognition of my name. It was clear that they had heard of me and knew who I was. I wondered what they had heard, and why I was the subject of conversation at all. I shook their hands, first the son’s and then the daughter’s. His handshake was brief, hers was not. She firmly held my hand in both of hers and with tear-filled eyes thanked me for taking good care of her dad.

“I know that because of you he lived long enough to see his grandchildren,” she said, “Thank you.” I did not know what too say. I couldn’t think of any particular treatment or diagnosis that justified her belief. I knew that I had loved her dad and done my best for him, but I did not feel comfortable being credited in such a way. I nevertheless mustered a feeble “thank you, it was my pleasure,” before turning away to allow others to offer comfort.

I exited the chapel stunned. I was totally unaware of how much I meant to the family, of how much my presence at the service was going to matter. My interactions with the man had always been brief, only rarely more than 15 minutes. How could I be so important?

It seems that I had underestimated the power of caring. While his conditions were not cured, his concerns were heard, his quality of life occasionally improved. He was not a heart patient to me, he was a man. Seeing him that way had made more of a difference than I could have imagined. Apparently, there are times when caring is as important as providing good care.

It is humbling to realize how close I came to missing out on the blessing given me by the family. They gave me much more than I gave them.

Bart