The 'New' Standard of Care in Medicine

It is my honest opinion that medical care in this country is headed for a major crisis if we do not rise up against the controls placed on us by insurance companies and Medicare.
12/02/2011 08:42 am ET Updated Feb 01, 2012

We are in an era of medicine where we can now make far more accurate diagnoses thanks to technological advances in diagnostic imaging and laboratory analysis of blood, urine, saliva and body tissues. We also now have at our disposal treatment capabilities that only a decade ago were not possible. Advances in surgery and medicine have vastly improved our treatment outcomes. Our improved ability to diagnose and treat has saved or prolonged millions of lives and has improved the quality of life for just as many people. For this, we must thank our scientists, engineers and physicians. Since I am a part of the latter group, I would like to speak to the enormous time, dedication, study and practice it takes to be a knowledgeable and skillful physician.

The practice of medicine demands a tremendous amount from our doctors -- from four years of college to four years of medical school to residency and fellowship training. In addition, physicians complete continuing medical education credits every year in different aspects of medicine with emphasis on their specialty. Society demands a lot from the people who are responsible for their health and rightly so. The stress and strain of studying and training to become a doctor can never be diminished, however; the tremendous satisfaction that it delivers when a patient has a successful outcome makes it worth every bit of its demanding commitment.

Make no mistake; doctors know what we're up against. We are trained to deliver the absolute best medical care and the public expects the absolute best from us. Errors in diagnosis, judgment and skill are not tolerated. We need to think and think clearly to establish an accurate diagnosis and we need to implement a protocol that has the best chance of a positive outcome. For this, we turn to peer reviewed studies, seminars, training workshops and mentorship after completion of our residencies. It is a profession that takes itself very seriously and places a high demand for excellence on all of its licensees.

So, given the time involved and the high level of commitment required to become a doctor, no one is in a better position to determine treatment options than physicians themselves. We not only look for reproducible studies that give us a high degree of confidence in what we do, we also self-police. All doctors in all specialties are held to high standards of excellence in education as well as clinical performance.

So it seems completely logical that it always has been physicians themselves that set the standard of care in medicine. Yet, that no longer seems to be the case. And this sets a very dangerous precedent for medical care in this country going forward.

Health insurance companies have been able to take over control of medicine through contracted arrangements with doctors. When a doctor agrees to "participate" with a health insurance company and become a part of their provider panel, he also becomes beholden to the terms and limitations set forth by the insurance company. Realize that an insurance company is not in the health care business. They are in the "keep the premium dollars" business. That means that they have a vested interest in keeping down the costs of medical care so that they can maximize their profits. By contrast, the doctor must hold to his oath of providing the best possible medical care while also doing his/her best to do no harm. Clearly, the insurance company/physician relationship can become contentious and adversarial because of these factors.

The truth of what is now happening in this country is that diagnostic tests and certain treatment protocols are being "denied" by insurance companies as "not medically necessary." In other words, they refuse to pay because they simply do not want to finance tests or therapies that cut into their bottom line more than they want them to. In addition, physicians face audits of their records by insurance companies and Medicare in which their records are scrutinized to see that every "i" is dotted and every "t" is crossed. If not, physicians are subject to demands for "recovery" of funds for services that were "inappropriately billed."

In addition, physicians who incorporate more progressive therapies are being subjected to withholding of payments, bogus peer review and licensure review boards. These "scare" tactics are working better than they should be. To avoid all of these uncomfortable and potentially damaging threats that are now looming over physicians, many are now fully "cooperating" with whatever the insurance company dictates as the "new standard of care" in medicine. In order to do this, physicians look for the quickest and cheapest way to address their patients so as not to stand out and become a sitting duck for an audit. Who suffers are both the patients and the doctors.

Morale in medicine is at an all-time low. Doctors are very unhappy and under the stress of constant scrutiny for every decision they make. It is the "guilty until proven innocent" phenomenon. Medical income is shrinking rapidly as well. It is my honest opinion that medical care in this country is headed for a major crisis if we do not rise up against the controls placed on us by insurance companies and Medicare. In addition to patients being under-diagnosed and under-treated, we are soon to see a crisis in which the incredible commitment to practice medicine and surgery will no longer be rewarded with the income that would draw the best qualified students to the profession. It will become increasingly hard to fill classes because far fewer people will want to do what it takes just to make a mediocre living. And who could blame them?

What is on the horizon is not going to be pretty. We cannot affect an improvement in "health" care if all we are going to do is to attempt to manipulate dollars and "sense."