The Disenfranchised Physician—The Patient Relationship

By Bob Sweeney

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One way to seriously demoralize physicians is to thrust them into processes that pit them against their very own patients.  A recent article in the New York Times on the “insulin wars” offers a salient example:

Of course, as anyone who has practiced medicine or worked for and with physician groups knows, the insurance and managed care industries have been dumping the tedious and more unpleasant parts of their claims management on docs and patients for decades.  So, your patient comes in, receives care, and gives you their insurance card. About two weeks later, you or the patient gets a letter stating that reimbursement has been denied or delayed due to a need for “more information”. That could be a lot of things, but what it actually accomplishes two things:  (1) the payer gets more time before paying, which means they get free use of the potential reimbursement cash for longer, and (2) the delay and call for extra information puts the patient and physician at odds. To all appearances, the payer is perfectly aware of these consequences, but doesn’t really care.  

Physicians and patients are supposed to have a relationship of trust.  I was reminded of this bond the other day during my colonoscopy (I don’t take sedatives because I like to watch the procedure).  Here I am letting another human being poke around inside me with a probe and a sharp little blade! What could be more clinically intimate than that?  But suppose I was mad at the doc, or the doc was frustrated with me, over past payment or documentation issues! It could just create a chill which undermines the feeling of confidence and trust on the part of the patient and the custodial role of the clinician during his or her practice.  

Physicians and patients need to be on the same side of the table.  Many forces, financial and otherwise, are working today to separate this combined interest.  Isn’t it in the long term public interest to keep this age-old relationship intact?


Robert E. “Bob” Sweeney, DA, MS

Principal & Managing Director