Pretty Poison

 Rock covered in tiny orange and pink anemone. 

“Doc, I went to the Doc-In-A-Box a few months ago with a sinus infection. They did a chest X-ray then gave me some sort of antibiotic and a cough syrup and something else I don’t even remember.” He shifted uncomfortably, as if he felt like he had been cheating on me. “Then I went a couple of months ago for abdominal pain. I had to do a CT scan but that was negative. They did a bunch of blood work. I don’t know what all they checked but they told me it was fine. The pain never went away, though.”

“Wait. Did you call here for an appointment?” Did my staff turn him away?

“Nah. My employer says I can’t see you except for my yearly physical. I have to go to a Doc-In-A-Box for anything else or it won’t be covered at all.”

Unfortunately, this was not the first time I had heard such a thing this year.  It is sold under the guise of convenience. I argued with the first patient. How could this be possible? Was it in writing? I asked her to bring in the documentation. I really wanted to see how it was worded, maybe she just didn’t understand?

She never did. 

Another variation is requiring employees to use the company’s approved teledoc services instead of calling their primary care physician. I handle stuff on the phone all the time for patients. It is safer to seek care from someone who has access to your medical records. Employers, however, like for you to never leave your desk… 

All of this leaves me wondering, when did we relinquish so much control over our healthcare to our employers?

“So, now that I am here for my physical, I was wondering if you can help me with this abdominal pain that I am still having. Lots of constipation.  It’s getting worse. Now my stools are dark black, and I am losing weight…”

I have yet to see official documentation of policies denying patients care with their PCP. The key is that even if there is not, employees think there is. Ultimately, in the erosion of the physician/patient relationship, who gets hurt? 

The patient. 

Way to go corporate America.

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85 thoughts on “Pretty Poison

  1. There is such a thing as human resources that is supposed to look after the employees. It is a matter of ethics and maintaining good work conditions. This situation seems absurd…

    Liked by 1 person

    • Right? I could not believe it at first. No way! Then the second one. That is odd. Then the third one… I still find it hard to believe. STILL, I have never had this said to me before and then to have one after another come forward with it…. Very upsetting.

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      • Reminds me of my days as a temp in hospitality. Avoid unsatisfied managers but clean up their mess at your expense. I was lucky in that I had a good contact at my agency.

        Still, it took a lot of workarounds to get things done. I became the the ghost of the building and was able to get almost anything from A to B.

        After a serious case of mismanagement I quit. Bad managers, no breaks and excessive overtime and temps to cover for a suit wearing idiots: it was not worth my pay.

        Liked by 2 people

  2. This is a very difficult situation Victo. The big issue is that the employer is paying the tab and he who has the gold makes the rules. I agree with you 100%- patient care should drive the process but like a lot of other things that we have monetized – it turns out that money drives it. I despise this and have no idea how to address it.

    As a colon cancer survivor, I shudder when someone reports black stool , loss of weight and abdominal pain simultaneously. **Shudder** I know that these symptoms can be indicative of many other issues, not the least of which is crohn’s and colitis (they first thought that was my problem before they discovered the cancer). How was his hemoglobin? – my tumors ATE red blood cells. You could hear them: Munch,. Munch, Munch. Ha!.

    I wish your patient the very best.- he has the best doctor now.

    Liked by 2 people

  3. I have been thinking for a while that we should decouple health insurance from the employer. My family’s healthcare needs didn’t change simply because I changed employers, but my ability to pay for insurance certainly did.

    I honestly would love to see what would happen if we force health insurers to compete with each other directly to the consumer. Let them duke it out with different prices, different plans, and if they REALLY want to raise the bar – good customer service.

    There would still be a long way to go toward fixing healthcare, but I think that would probably be the easiest place to start.

    Liked by 2 people

    • The problem with that is what we had before. They charge you a fee and then go through your old medical record with a fine toothed comb and then deny coverage because of some obscure, silly thing that may or may not be real, all because you are diabetic or getting too old. They don’t want sick patients because they cost money.

      Liked by 1 person

  4. I wonder if these corporations will get the message that this is a bad idea when they have to open a new department designed to quietly dispose of the bodies of deceased employees who are still at their desks, having failed to contact their doctor when they really needed to?

    Liked by 1 person

  5. here’s my reality…i’m 52 and want to clean-up my credit because I want my own place…I went to the hospital e-room…on insurance…now I have yet another negative report against me…over $800 due the hospital and another $300 to the doctor!!! don’t insurance rock??? for the record I intend to retire at 62…i’m tired of working for the nan!!! and I might end up under a bridge near you

    Liked by 1 person

    • Another awful scam is the free standing ER’s that are popping up everywhere. They are more expensive (try $7,000 CT scan), provide poor care, and if you really are ill they are going to call the ambulance and have you taken to the real ER. They should all be outlawed.

      Liked by 2 people

  6. Wow, that’s crazy!

    My husband got some paperwork about the teledoc service from his company a couple weeks ago. He said it would be more convenient, but I pointed out he gets two weeks of sick time and should actually use it when needed. He’s told me that it “looks bad” to use sick days and all of one’s vacation time. šŸ˜³

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  7. Is there one enormous employer in your area calling the shots? Or are the docs in boxes paying kickbacks? I’ve never heard of such a thing.

    I did recently read, though, that there is a new really expensive healthcare scam. Medi-vac. Private companies bought lots of helicopters to medi-vac folks in case of accident or emergency. Now, to pay for the helicopters, they are swooping down on the scene of an accident before the EMTs, and whisking folks away. And then sending them a whopping bill. Many insurance companies don’t/won’t cover the cost and it is often in the 10’s of thou$ands. And the people who’ve just been in an accident are generally in no condition to complain until later.

    Somebody’s always got a hand in our pockets…

    Liked by 1 person

  8. If employers would get their head out of the sand and actually think for a moment they would realize it costs significantly less time and money for employees to see their PCP for everything. Doc-in-a-Box has to ask more questions, do more tests, and take more time to figure out, oh yea, this is the same (for example) ear infection you get every year at this time, whereas the PCP is more likely to recognize that much sooner, with fewer tests.
    My company went through the annual enrollment recently. The only “directive” given to us was to use urgent care over the ER, but that was it.

    Liked by 1 person

  9. I’ve never heard of this! It’s a truly disgusting evolution of corporate health care. If this turns out to be serious (i.e. colon cancer) I think this guy would have the basis for a law suit against his employer. Take good care of him!
    On another note, the IRS just issued a new tax (which is strictly illegal), charging employers $100 a day for each employee whose health care they subsidize in whole or part, up to $36,000 for a year. I just don’t get it.

    Liked by 1 person

  10. Hey Victo,

    A sad tale, and a very disheartening day when the worth of a human life became a monetary value.

    It seems our life with an insurance company begins with projected profit but ends in our assured loss.

    Keep going with your sterling work and writing.

    Namaste

    DN – 08/07/2015

    Liked by 1 person

  11. Over here we are probably where you used to be. Those who are well looked after through work health care are very well looked after and yearly get a very thorough MOT screaning for everything.
    Reading this I hope we never turn the corner your country seems to have gone around.

    Liked by 1 person

  12. Geeze… I must be in another world… Doc in the Box? Really…. we have telehealth which is only a monitoring system that actually goes to a live nurse if you are out of your ordered parameters. That’s it! We have phone coaching and counseling, but no MD on the phone. They won’t prescribe unless you come in. Maybe because we live in the area of many huge medical systems…. maybe because my agency is an affiliate, we don’t hear about this. We push wellness up the wazoo… we do our free health screenings for our staff, inoculations free, and we are connected to OC-Med for services due to injury from a work related accident. We have to report health changes and are supposed to get a physical annually paid by our insurance. Our premium is high for families, reasonable for individual, but we are totally covered.

    Liked by 1 person

    • The health screenings done by employers bother me, too. Does it matter to your job function what your cholesterol is? No. Why do they need to know that? Doc-in-the-box is like those pharmacy afiliated “clinics” or urgent care facilities. One company requires their employees to get their annual physicals done by an NP at a Walgreens pharmacy and will not cover it with their PCP at all.

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      • I completely agree about the health screening. when they first did it, I had a fit. I have PsA and take a nasty expensive drug. But I also figured, with the litigious world we are in, I will scream discrimination if they ever try to do something about it. We also have to declare medications, which is also scary because the nurse in HR reviews them. We have some pretty stoned out clinicians who take heavy meds. (I am not supposed to know that but I do)

        Liked by 1 person

      • I am not sure I agree with someone knowing all of your meds. Drug screening? Sure. Do it randomly. There is no reason for my employer to know if I am taking a cholesterol medication, though. That is none of their business.

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    • Wtf? …is right. I am increasingly interested in a single payer system. Some physicians may feel that is a betrayal to my profession, but can it be worse than what we have now? I am finding that harder and harder to believe.

      Liked by 1 person

      • Biggest health insurance in the country is single-payer. Medicare. It ain’t great, but it would simplify a lot and it would get the workplace out of our health “care.”

        Liked by 1 person

  13. To my knowledge we’ve not been “told” we can’t go to our primary doc. But….insurance sure makes it a point to put in a rate that charges different levels of copays for the services they want you to use. For example: urgent cares over ER. Even though the urgent cares aren’t open at night. So many different (higher) charges for services they do NOT want you to get. It is ridiculous the amount of power insurance and corporate worlds have over our health care.

    Liked by 1 person

    • I had a woman yesterday who needed a breast biopsy. $3,700 out of pocket because of her huge deductible. Turned out to be nothing which is a relief but to be out that much money for nothing? Shameful that it should cost that much in the first place. Thank goodness she had the money for it but very few of my patients have that kind of cash lying around. Broken system all around.

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  14. Pingback: My Article Read (7-9-2015) | My Daily Musing

  15. corporate America and big government have ruined everything in this country and though they’d like you to believe that they are at odds with each other, the reality is that they’re not. They each have the same objective, to control as much as your life as they possibly can. The illusion that they are at odds with each other is a way to just misdirect the people.

    Liked by 1 person

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