Being an Advocate for Your Patients

Even though I have been practicing medicine in an atypical, concierge practice model, there are still instances where I sense a growing adversarial relationship between the doctor (me) and my patients. More so as our economy is strained to the breaking point. It got me thinking: What does it mean to be a modern day “advocate” for my patients? Has this role changed significantly from my earlier days where I felt I worked solely for my patients?

With the advent of the third party payers, physicians essentially entered into legal contracts with the insurance companies, unintentionally introducing a financial bias into the physician-patient relationship. In my view, this is in direct conflict with the Hippocratic Oath, which of course holds patient advocacy of primary importance. This new relationship has forced docs to re-examine their priorities. Are they working for the insurance companies? Or do they really work for themselves and their patients?

Think of the classic example where a physician chooses to code a preventative-care visit as a problem-focused visit, in order to help his patient. He may think he is being an advocate for his patient, but he is also committing insurance fraud en-route. Under the HMO capitation model, patients feared the reverse: Physicians withholding procedures in an effort to save the insurance companies money.

But the most frustrating example of the increasing disconnect between patients and their physicians is when a patient is refused insurance coverage because of a diagnosis that was made (and submitted to the insurance company) by his physician. We all dread these types of calls from patients, “Doctor, something in my record prevented me from getting the preferred rate for my life insurance!” A CPT code made appropriately, or worse, as a stretch to attempt to cover a lab test or procedure, has now come between you and your patient.

If you are wondering how this happens, I can tell you that it is the work of the Medical Information Bureau, a 105-year-old, 470 insurance-company strong “information exchange.” Think of it as the DMV or Equifax of medical diagnoses whereby your diagnoses, quickly scribbled on the bottom of an encounter form after a seven-minute encounter, are submitted to insurance companies via a clearinghouse, and live on in the digital ether for seven years.

In an attempt to simplify my allegiances, I have decided that I work solely for my patients. I see them, make diagnoses, and treat them. In return, if they value this process, they pay me.

If you are concerned about your relationship with your patients, here are a few strategies to help you become a better patient advocate:

• Learn about the MIB, www.MIB.com, and educate your patients about the potential for harm from reporting their diagnoses to their insurance companies;

• Give thought to other areas of your practice where your role as a patient advocate has eroded; and

• Consider a cash-based practice to return to the days of pure patient advocacy and, as I call it, the “just say yes” mentality.

David Albenberg, MD,

a board-certified family medicine specialist, opened South Carolina’s first retail medicine primary-care practice, Access Healthcare, in 2003. He focuses on disease prevention and wellness maintenance. He can be reached at accesshealthcare@letssimplify.com.