Her agitation was clearly apparent, plastered to her face like the smile she had worn moments ago. The phone was still clenched tightly in her hand as she paced the narrow hallway, muttering under her breath how travesties like this would not occur back in her native Ghana. In my mind, I wondered how one phone call could have such an effect on Dr. X (as I will refer to her for the sake of anonymity), the physician I was shadowing for the summer. She turned to me and said one word, as if in that single utterance she had summed up the very nature of evil in the world: “Insurance.”
The moments leading up to this phone call began under the least auspicious of circumstances. One of the patients admitted to the hospital had come in with fever and general unease, symptoms that are standard in the routine checkups of a hospitalist. What stood out, however, was the patient’s white blood cell count — a whopping 22,000 per microliter of blood! This number may not mean much to you if you haven’t gone through medical school or shadowed with a doctor good at explaining patient charts, but the normal white blood cell count for a patient of this age is approximately 10,000 leukocytes per microliter of blood, putting the patient at over two times the upper limit of normal. As we were looking over the chart and deciding whether to administer empiric antibiotics, Dr. X’s hospital phone rang; it was the patient’s insurance company. The call took approximately 20 minutes but spelled what could be potential long-term impacts for the patient. As Dr. X explained, the insurance company’s medical representative (who was in New Mexico, while we were in Louisiana), repeatedly told her that the patient did not need to be hospitalized and that the leukocyte count of 22,000 was nothing to be concerned about. What is concerning is that a licensed medical professional from the insurance agency could so unabashedly state that a clear sign of infection or another complication was simply a “pollen allergy,” as his report put it. What’s frustrating for many physicians is that they are hindered in their efforts as they try to do what is best for their patients. As Dr. X said, “How are we expected to treat patients if their insurance companies are trying to stop us every step of the way?”
The underlying problem seems to be that insurance companies operate on a profit-based system, a philosophy that usually utilizes a cost-versus-benefit weighing mechanism in decision-making processes. In the case of our patient, the insurance provider saw that a significant cost would be incurred by hospitalizing the patient. The patient’s health takes back seat to the cost of treatment. There are two immediate problems that come about because of this mindset. First, the paperwork that doctors incur limits their working time and decreases efficiency. Phone calls and paperwork can limit the amount of time a doctor can spend with each patient. Decreased doctor-patient interaction leads to the patient feeling under-informed and overwhelmed. The second and arguably more detrimental impact is that it limits the measures of treatment a doctor may feel are necessary for the patient. Insurance companies are well-known for denying insurance to patients with “high-risk,” preexisting conditions. However, a recent trend has revealed a much more alarming series of events, in which even necessary care is being denied. Cardiologist Dr. Kevin Campbell explains, “Increasingly, insurance companies are overruling physicians’ recommended treatment plans in the name of cutting costs.” He goes on to explain further that many of the treatments and procedures he recommends for his patients are often denied by insurance reviewers as being “unnecessary.”
As a college student approaching his junior year of pre-medical studies, the word “insurance” evokes little emotion in me. Before I began shadowing Dr. X, I didn’t realize that doctors often had to battle external factors in order to treat their patients. Unfortunately, it seems that many doctors leaving medical school and beginning their journeys don’t realize the forces that they’re up against either. The new graduate recognizes that he or she must know how to bring down the heart rate in tachycardia or the proper empiric drugs to administer per the symptoms exhibited by the patient, yet few anticipate the loops they must jump through with insurance providers. This problem of insurance corporations and the monetization of the medical industry is not a problem I can offer a solution to: I neither have the qualifications nor the expertise to suggest the implementation of policies to correct this epidemic. However, what I can advise in my humble experience as a pre-medical student, a doctor-in-training and as a fellow citizen is that the decision of what insurance company to take on is not one to be taken lightly. Do the research. Take the time to see which companies provide the most coverage and have the best reviews. And above all, recognize that your care as the patient should always be the priority.