Insurance companies need to stay out of provider-patient relationship | Opinion
Robert Minard lives in Portland. His latest novel is “Love and Work.”
I’d like to say a few words to Dr. Jeffrey Barkin about his recent plea for less administration and more expediency in prescribing medications to help patients (“Time to free doctors from prior authorization,” Opinion, Aug. 9).
He is an empowered laborer in a field that empowers many others, like myself, to labor in a similar field, and I am grateful for the opportunity to work and take care of myself. I would ask him a question in reply to his polite, conversational suggestion for improvement but none come to mind. So instead let me explain.
It sounds to me like Barkin and his colleagues face a dilemma not unlike one that I face on a regular basis when I visit a psychiatric-mental health nurse practitioner to review, update and reauthorize my own psychiatric prescriptions.
Every three months now — it has been 11 years that I take my current prescriptions and 23 since I first stayed in a psychiatric hospital — I visit or meet remotely to explain how I am doing and how I think my medications are doing and consult about what is healthy or could be healthier. Just writing to explain what happens makes it sound tedious I think, but that is really my point.
I often find myself thinking that I could be doing something else like working — I’m a writer — or figuring out how to arrange to send email to my 5-year-old nephew who is learning to read, or just basically not stopping everything to formally account to a near-stranger who changes every few years my personal thoughts on mental health in a way that fits into their appointment schedule and tries to accommodate their own education and views on the efficacy of their life and job.
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It often seems like a chore, I admit, but one of the coping skills that I have taught myself in the course of being a mental health patient is to accord the gravity of these meetings not the breezy, by-the-numbers perfunctoriness that they often invite but a small measure of the actual importance they have to my life.
Somewhat like grammar for instance, these relationships are as important to me as breathing and they have dependencies. I try to coordinate and respond to questions predicated upon the assumption that I am transparently candid and always able to name my complaints, and that someone else — in this case in as egalitarian a way as possible — has the human experience and scientific know-how to adjudicate a measure of relief.
Doctors must surely find the extra administrative steps to satisfy a third party’s interests not only tedious but an impediment to their own human efforts to fulfill the expectations of a reciprocal attentiveness.
“What does it cost?” is apparently a valid question, but does insurance companies’ insistence upon the implicated responsibility of the prescribing doctor really help? The medical profession does an extensive job of administering the responsibility for oversight; can’t they relieve doctors of many clerical duties?
Insurance companies are right for wanting to assign responsibility for economy to an expert, but they are out of step with the medical industry, which delegates care liberally. It seems like the sticking point is in all parties’ expectations of consideration. Necessity is much more colloquial and mundane than the companies seem to assume.
Or perhaps the real question is how much is the cost of “human” consideration? In his essay, Dr. Barkin is clearly asking if there is some point beyond which a form of care like pharmaceuticals that affect a patient’s well-being can be agreed to be taken for granted. The medical profession doesn’t take it for granted, and the patient can be expected to care. That only leaves the cost to be accounted.
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