Many Doctors Withhold Info From Patients

[spinbaby]

WASHINGTON - Nearly one in three doctors reports withholding information from patients about useful medical services that aren't covered by their health insurance companies, and the number may be on the rise, a study reports.

Study authors say their work offers the first empirical evidence for what many have long suspected: that coverage limitations imposed by managed care are infiltrating doctor-patient communications.


http://story.news.yahoo.com/news?tmpl=story&u=/ap/20030708/ap_on_he_me/silent_doctors_3

[Betty]

1. This is yet another reason

why I rarely see a doctor for anything.... they rarely help
me, I find.  Knock on wood, I am pretty healthy.  When I do go
in for checkups, etc., the doctors spend as little time with
me as possible.  They have to cram as many patients in as
possible.  I seriously doubt that they catch everything they
should.

[Ramsey]

2. This is a complex issue

As the article admits, the meaning of "useful service" was not even defined in the survey, and was probably broadly interpreted by respondants. I would have thought the concept of a "necessary service" or "all appropriate treatment options" might have been a more meaningful parameter. For example, sometimes we cannot write for brand name drugs, or certain classes of drugs because the insurer won't pay for them, and the patient cannot afford to pay out of pocket. I might think one drug is better or more useful, but be unable to prescribe it. Granted, I usually find this out the hard way: prescribing the drug only to get a call from the patient or their insurance telling me its not acceptable.

I cannot imagine how a physician could even begin to know what services to withold information about based solely on type of insurance. In my practice (radiation oncology), every single patient gets offered the same exact work-up and treatment options that are appropriate for their type and stage of disease, regardless of their type of insurance. Our business office does get approval for coverage from the insurer (or we get the patient signed up for assistance if they come in without insurance) before we are even allowed to do a consultation. But we never leave a patient high and dry. If they are not capitated to our hospital (which is rare for cancer services), then we find them a place where they can be seen and make sure they get an appointment there. But once a patient is under our care, I wouldn't even be able to tell you what their insurance was, nor do I care to. The only way I would even be aware would be if the particular insurer requires me to do some special paperwork or documentation, or if they have lots of rules and restrictions regarding the ordering of tests. We are constatntly fighting with insurers to get people appropriate care. I cannot tell you the number of practically threatening phone calls and letters I have written arguing for a patient to get a particular drug, test or procedure after they have been denied.

Overall though, we have so many patients using so many different insurers, all with their own particular rules, restrictions, forms and requirements, there is no way I could ever remember what one company allows versus another. In my practice, the Medicare patients are among the easiest to take care of, because the coverage is much better and broader and more lenient with respect to the physician's recommendations than most of the HMOs we deal with. And Medicaid, in PA anyway, isn't too bad.

In New Jersey however, with recent massive budget cuts, some people who are already our patients (we are the closest cancer center for many who live right across the Delaware River in NJ) are being told they cannot see us any longer and coverage for services in-state have been drastically reduced as well. I have one patient (with a rare cancer and lots of complications) whose state assistance ended coverage of any in-hospital service. Since nearly every radiation center is hospital-based, they bascially eliminated her ability to get cancer treatment and follow-up.

So, I would think that more often than denying people treatment options up front based on specific knowledge of the type of insurer, it would be far more common to have made a recommendation only to have it denied by the insurer, and then to have to reassess the remaining options. But as for being "conditioned to withhold information", that just doesn't ring at all true in my experience.

[DrGonzoLives]

3. But we don't need any kind of universal health-care

to take away this incentive...nope, not at all, the market works here, right?

[teryang]

4. Be wary!

Of the so called risk benefit analysis.

Drug companies often withold or minimize information concerning serious side effects seen during clinical trials or known to occur with related drugs in the same class. This is especially bad with new drug labels where the track record doesn't involve a large enough data base or long enough trial period. Yet these are the drugs that the drug companies are pushing because they are still under patent and support high prices. I've recently saw a clinical trial where patients are not even advised of known or reasonably anticipated side effects. Beware of labels that warn of using a drug with pre-existing conditions, such drugs may later be found to be associated with the condition allegedly attributable to the preexisting source. A common explanation is "pre-disposition."

Even where a label does refer to a risk in some way, Doctors are understood to hold back on what they know of published risks or known side effects, so as not to alarm or confuse the patient unnecessarily. They do the risk benefit analysis for the patient. By editing the label data, the limit the patients understanding of the risk benefit analysis. This is called the learned intermediary doctrine.

I read the PDR and search the web for info on drugs. The FDA site is a good place to find info about drugs that may be problematic but haven't been scientifically proven to be so. Ultimately, the expert opinion of a qualified MD is best, but you'd be surprised at the lack of depth some doctors have about the new drugs they recommend.

IMHO