“Your mammogram shows an area the radiologist is recommending that we biopsy. I am going to put in a referral for you to see a breast specialist to get that done.”
“Um. I already have the biopsy scheduled. The radiologist said they could do it. It has been approved by my insurance and everything.”
I glanced at the time stamp on the mammogram report. She’d had the mammogram done just that morning. The report summary said “suspicious calcifications concerning for malignancy….”
“I would really rather we get you hooked up with a breast specialist to do this.”
Who do they think they are, scheduling my patients for procedures that I have not even authorized yet?
“I’d rather just get it done. It’s already scheduled for next week.”
“Look, I can get you in with the specialist in just a few days. This is not going to delay care in any way.”
Suspicion began to creep into her voice. “I really don’t want to,” she said firmly. What exactly had they said to her?
How do you say, “I think you might have cancer,” without causing panic? How do you remain professional when you are seething inside?
If it were me, if it were my mother, I would want to have the biopsy done by a breast specialist, not a radiologist. They have surgical training but more importantly, they know what to do if god-forbid-it-turns-out-to-be-cancer. Instead of waiting to see someone that can take the next step, I would be already plugged in. I have seen it too often. The panic, fear… the rage…
My patients deserve the same care I would get, the same care I would demand for my loved ones.
I knew how it was going to go, though:
“If you don’t stop doing this, I am going to stop sending my patients there for mammograms.”
The manager laughed at me through the phone. “You have to send patients to our facilities. We are in the same system. You know they track that sort of thing.”
And she’s right….
The suit squinted at me from across the table.
“So, in analyzing the data from your mammogram referrals we see that you are sending about 52% of your patients to outside facilities. Care to elaborate on why that is?”
“Is it required that I send patients to only system facilities?”
“Oh, no. No. It’s not required.”
That would be illegal.
“So why are you here talking to me about this again?” I could feel the pricks of anger rising under my skin.
“We can’t require you to do that but in the interest of managing costs for patients…” He trailed off.
In the interest of keeping more money in the system…
I held back a laugh.
It was an interesting thing, how much more frequently my patients getting mammos at system facilities seemed to end up getting biopsies compared to those facilities outside the system that did not do biopsies as part of their services. Did they track that, I wondered? Was my perception about this correct or merely a projection, tainted by the animosity I felt? I resolved to start keeping a tally.
“While we are on the subject, your referrals to system specialists is below the system average for primary care. Why?”
“The why depends on the patient. Some prefer to stay in the area. Driving downtown is a hardship for a lot of them, not to mention the cost of parking. Some need a physician with a certain set of skills or a certain personality. Some have experience with a physician through a family member or have been seeing this specialist for years and need a referral each year because of their insurance.”
Why am I justifying this to you?
A month ago they added a button on external referral orders that requires me to provide an excuse so they can better track such things. If there was a “bite me” option on the choice list, I would use that.
Previously they had only loaded the contact info for physicians within the system. If they were not a system specialist they had to be loaded manually by filling out a form that went to the practice manager then to a practice administrator and then to a VP and then to someone to add them in. It took weeks.
“Provide us with a list of the specialists you would like to use and we will contact them to try to get them to join the system.”
“I’m not doing that. I’m not letting you use my name to convince them to join anything. If they want to join, they can look you up. Meanwhile, I will continue to refer in a way that keeps the best interests of my patients as a priority.”
Technically they could pull those names from electronic health record. Maybe they already had.
“Oh, we always want you to keep the interests of your patients as a priority. We would never ask you to do otherwise.”
Except that is not how it feels…