Nonadherent Patients, Prior Approvals - Sometimes a Doctor Just Needs a Vacation

I just spent the weekend on Belleair Beach, celebrating Elke’s birthday with a bunch of friends who rent motel rooms, soak in the sun—I know, I know—barbecue, imbibe an occasional alcoholic beverage, and just have a good time over Memorial Day weekend. And FYI, there’s no oil yet on the West Florida beaches. But with hurricane season starting today (June 1), the environmental disaster is sure to get worse.

As far as I was concerned, I needed a break, especially after the Friday I had.

A female patient, in her early 40s, decided three months ago that she was going to stop taking her Crestor because it was rather pricey. Knowing it can cost upwards of $120 a month for cash-paying patients, I understood. But to my surprise, she told me it was the $75 for a three-month mail-order prescription that she couldn’t afford. To make a long story short, she burns up about $140 worth of cigarettes a month in lieu of treating her cholesterol (which was over 300). I’m not sure what to do with patients like this, so I just shook my head and tried to make her feel as guilty (and, truth be told, as stupid) as possible. I gave her a prescription for a cheaper generic statin in hopes that she’d take SOMETHING.

Another patient, a male in his late 30s, had been complaining of left hip pain for a few weeks. The pain was actually above the pelvic brim, not in the hip joint, and I felt it was most likely a soft tissue injury he sustained when he twisted while rock climbing. I treated it very conservatively for a couple of weeks but the pain persisted and was keeping him awake at night, so I ordered an MRI, knowing it would have to be approved by his insurance company. We received a denial letter because there had been no plain x-ray taken. The letter stated that the reviewing physician was an OB/GYN.

After my 30-second tirade, I asked my staff to get a medical director on the phone. He called at the scheduled time of 9:30am. He was an orthopedist and I thought, “This is going to be easy.” But someone had misread my writing of “brim” as “bruise,” so he thought the x-ray was needed. I told him there was no mention of a bruise in my notes and that I was pretty sure it was a soft-tissue injury. He relented and okayed it. Then, after all of that, we got a call from the diagnostic center notifying us that the patient had declined the MRI due to his high deductible. That was worth a 15-second tirade.

The patient came in on Friday and explained that he had a $1,000 deductible and the MRI would take up most of that. But he had been told that if he paid cash, it would be only $250. He was a bit bewildered, but I got it. But the better news was that his pain was actually 80% better, so he really thought he could do without the test. I couldn’t have agreed with him more. And I really was glad that he was doing better.