Diagnosis: A sick health care system
Amherst doctor emerges as national voice on problems in U.S. health care system
Thursday, September 3, 2009
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The patient had chest pains, and Dr. Kate Atkinson wanted to administer a cardiac imaging stress test. But first she had to get authorization from the patient's insurance company.
"My nurse was on the phone for 45 minutes, so I picked up the phone and said, 'How do you sleep at night?'" she said. "They said they couldn't OK it unless they had a code number. The patient could have died, and I'm paying people by the hour to sit on hold. It's ridiculous."
Some people may be worried that health care reform will put the government between them and their doctors, but Atkinson said there's already an insurance company there.
"I worry that people don't realize how much insurance companies control whether you're getting good health care," she said.
At 47, she's a doctor in Amherst, like her father before her. But her influence is much broader, as she's become a national spokesperson for the problems of excessive paperwork and the scarcity of primary care physicians.
She was on the CBS Evening News Aug. 18 talking about the bureaucratic demands on her staff of 11, and losing one employee to Starbucks because it provided better benefits. Her media exposure began when the New York Times asked the Massachusetts Medical Society for the name of a doctor in a rural practice, and she wound up being quoted on the front page in April of last year.
Since then, her comments have appeared in the Boston Globe, Wall Street Journal, USA Today and U.S. News, and she's appeared on PBS on "The News Hour" and on NPR's "Marketplace." She gets lots of emails from doctors thanking her for speaking for them, she said.
As the health care debate heats up again in Washington, Atkinson said she'd gladly make less money if it meant she didn't have to jump through so many hoops.
"Insurance companies care about insurance companies," she said. "It doesn't make sense for them to manage primary care. That's not what they were built for. They insure things that are not supposed to happen, like a house burning down, not everyday things like asthma."
Insurance woes
One of the biggest problems is that each insurance company has its own system and it's difficult to keep up with all of them, Atkinson said. "A lot of money gets spent that doesn't remotely benefit patients," she said.
Insurance companies now have high-tech ways to look at a person's prescription drug usage before deciding whether to grant coverage, and in some cases they are learning personal information about impotence, depression and thoughts of suicide, she said. That itself can deter people from seeking help, she said.
For example, Atkinson had a patient who wasn't an alcoholic but drank too much when he went out, and wanted a prescription for a drug called Antabuse that makes you sick when you're drunk. He later applied for life insurance and was refused because of the prescription. Trazodone used to be prescribed as an anti-depressant but is now though to be effective only as a sleep aid, and now some people who have taken it have been denied health coverage, she said.
Some doctors have gotten so fed up that they won't deal with insurance companies and charge every patient $50, and wind up making more money that way, Atkinson said. She sees some patients who lack insurance and pay in cash, with a 40 percent discount, she said.
Most of her patients have insurance, but often it's inadequate. "But they don't find out until they get sick," she said.
It's good to see so many people focusing on health care, "but the disinformation is scary," Atkinson said. It can be traced to the insurance companies and their political and financial clout, "because they stand to lose a great deal," she said.
Two elderly patients really seemed to believe that health care reform will produce "death squads," Atkinson said.
She favors a single-payer system, but since that's not on the table, she's for the "public option," because it would compete with insurance companies.
Care already rationed
As for the fear of "rationed" care, she said that's already happening. "I was refused fluoride treatments for a baby, but on the other hand I can get stomach staples for a patient to lose weight," she said. "Someone makes doctors do things all the time."
One elderly patient had very high blood pressure and was at risk of a stroke, Atkinson said. It took her eight months to convince the patient to go on medication, but the patient got a letter from an insurance company questioning her doctor's judgment, she said. The woman stopped her treatment.
Part of the problem is that Americans "want top-quality medical care, keeping people alive at any cost at any age, but are not willing to pay for it," Atkinson said.
"Everyone wants the newest and best thing," she said. "They demand an MRI, and I say they don't need it because a clinical exam is just as good. Then they insist and I say 'OK,' and that drives up the cost. People should bear some of the cost when it's something their doctor thinks they don't need."
Way of the 'dodo bird'
Atkinson's practice, which includes another doctor and a nurse practitioner, costs $3,500 a day to maintain. She herself has 3,500 patients and isn't accepting new ones. Anyone who's sick is seen the next day, but the next time she's available to do a physical exam is Feb. 10, 2010.
Twelve years after graduating from medical school, Atkinson still has $60,000 in student loan debt, and has started working one night a week at Cooley Dickinson Hospital to help pay her family's bills.
"When I was growing up, doctors didn't need to moonlight," she said.
About 20 primary-care doctors in the Pioneer Valley have bailed out in the past two years, she said. She's worried that doctors like her are "going the way of the dodo bird," and some patients have called her in a panic "feeling like I was the last one standing," she said.
Part of the problem is that specialists can make several hundreds of thousands of dollars a year. "I've never made more than $150,000, not even in a good year," she said.
But it's also a matter of disrespect, she said.
"Our culture thinks emergency rooms and intensive care units are exciting," she said. "It's not sexy to prevent a heart attack. What I do doesn't look glamorous to an outsider. It doesn't even look medical."
Comments
Great Kate
Keep speaking up and out -- maybe it'll get thru some thick skulls.
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