The healthcare landscape has experienced significant evolution over the past few years. Group Health, Occupational Health, and everything in between has been materially affected by rules and regulations where the patient is not always the central focus of the implemented standards; other stakeholders’/shareholders’financial interests take precedence over patient recovery and preserving the importance of the physician’s role as the patient advocate becomes an afterthought. Healthcare as a whole, must return to a place where clinicians are the drivers of clinical decisions for their patients.
An excerpt of Dr. Linda Girgis’s (MD, FAAFP/Family Physician; New Jersey) book, The Healthcare Apocalypse (CreateSpace Independent Publishing Platform (April 7, 2016), included in her blog “Patients, Stand Up for your Right!” speaks to the weakening of physician participation in determining the outcome of patient recovery (http://drlinda-md.com/2016/05/standupforyour-rights/). Dr. Girgis brings up two examples that translate well into Workers’ Compensation:
- Being prescribed a medication for a specific condition only to be denied by the pharmacist and told that the insurance company does not cover that particular drug.
- Ordering an MRI only “if the patient needs it” and challenged downstream by an insurance adjuster using a “predetermined set of guidelines” as the basis for the challenge.
Both scenarios above are frequent occurrences in the world of Workers’ Compensation; both scenarios encounter show stoppers (the pharmacist and the adjuster) that have never seen or even spoken to the patient. Their influence on the outcome of the patient’s recovery now supersedes the physician’s influence.
The shift of influence is a byproduct of over-zealous entities placing claim on thefinancial value of healthcare and on the other side of the spectrum, sincerely concerned stakeholders are over compensating to regulate bad-acting physicians (think of the doctors who are overprescribing opioids and rampant over-utilization of other treatment/diagnostic testing) while stifling patient-centric practitioners. The answer lies somewhere in between with physicians marrying their expertise with scientific evidence to deliver the highest quality care to their patients and SPEAKING UP when show stoppers misappropriate credible evidence.
“Doctors are in a unique position to advocate on behalf of patients, and they must.” (Linda Girgis, MD, FAAFP)
A physician’s clinical expertise and direct line to the patient are the ideal foundation to build on. Provided with the right tools at the point of care and a patient-centric focus, a provider is the only party involved in the process with all of the pieces in hand to make sound, informed treatment decisions to usher the patient back to health.
A physician can be, and must be, a patient’s greatest advocate.