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I wonder how this topic has stayed out of the media or why it isn't being discussed more by physicians and ... well ... us.
Last night I was at a book club meeting where one of the physician members admitted that they were now giving their patients 1 year to "lose weight, quit smoking or get their diabetes under control" or they "wouldn't be able to see them anymore". Insurance companies new quality measures rate physicians by the patient outcomes and apparently, these 3 (and I think blood pressure) are top issues. Physicians, of course, have not real control over what their patients eat, whether they quit smoking or exercise and can do no more than guide patients. They will, however, be dinged financially for their patients' lack of compliance...several thousand dollars.
I was horrified by this and talked to dh ... who ... gulp ... confessed that he no longer takes HIV patients who are actively abusing drugs. He refers them to the cities. He said he doesn't want patients who are non-compliant, develop multi-drug resistance, and take large quantities of time that are likely not re-imbursed. He will take any patient actively in a drug rehab program of some kind, but if they "come to his office high", that's it ... and he tells them from the start.
They are referred out for HIV care and they are always welcome back if they get their drug problem under control. Active drug abuse correlates with very poor drug compliance and increased issues. I was pretty upset with him at first, but I started to understand his point-of-view because I know how busy he is, that he goes above and beyond for his patients (coming in at night or on weekends even when he isn't on call or might not be reimbursed) and I, too, wonder where he would pull the extra time to handle patients who are active drug abusers .... He also feels that this ratings system is coming for specialists too.
So ... what happens to those of us who are imperfect? I'm overweight ... it isn't my doctor's fault. Actually, my doctor is overweight too. LOL. I guess he and I will both be trucking out to the a public clinic somewhere for healthcare?
What do you guys think about this? Who will see imperfect patients? Why aren't doctors making a big public issue about this?
Kris
Last night I was at a book club meeting where one of the physician members admitted that they were now giving their patients 1 year to "lose weight, quit smoking or get their diabetes under control" or they "wouldn't be able to see them anymore". Insurance companies new quality measures rate physicians by the patient outcomes and apparently, these 3 (and I think blood pressure) are top issues. Physicians, of course, have not real control over what their patients eat, whether they quit smoking or exercise and can do no more than guide patients. They will, however, be dinged financially for their patients' lack of compliance...several thousand dollars.
I was horrified by this and talked to dh ... who ... gulp ... confessed that he no longer takes HIV patients who are actively abusing drugs. He refers them to the cities. He said he doesn't want patients who are non-compliant, develop multi-drug resistance, and take large quantities of time that are likely not re-imbursed. He will take any patient actively in a drug rehab program of some kind, but if they "come to his office high", that's it ... and he tells them from the start.
They are referred out for HIV care and they are always welcome back if they get their drug problem under control. Active drug abuse correlates with very poor drug compliance and increased issues. I was pretty upset with him at first, but I started to understand his point-of-view because I know how busy he is, that he goes above and beyond for his patients (coming in at night or on weekends even when he isn't on call or might not be reimbursed) and I, too, wonder where he would pull the extra time to handle patients who are active drug abusers .... He also feels that this ratings system is coming for specialists too.So ... what happens to those of us who are imperfect? I'm overweight ... it isn't my doctor's fault. Actually, my doctor is overweight too. LOL. I guess he and I will both be trucking out to the a public clinic somewhere for healthcare?
What do you guys think about this? Who will see imperfect patients? Why aren't doctors making a big public issue about this?
Kris
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