Focus health system on patient, not profit
On Aug. 1, my wife was diagnosed with breast cancer. The biopsies of both the lymph node and breast came back positive with “poorly differentiated” cancer. This means the cancer is aggressive.
That was a Friday. On Monday, we went to the oncologist.
The oncologist explained that before we could proceed with a diagnosis or treatment we would need to do a battery of tests to determine the extent of the cancer’s spread. To determine if the cancer was genetic she took a family history and ordered a different test.
The tests ordered were a PET/CT scan, an MRI and a BRCA. The oncologist also had vials of blood drawn.
We proceeded to the desk to schedule our tests. The response was, “until the insurance company approves the tests, we cannot even schedule them.” We scheduled a consultation with the surgeon for Wednesday. We left the office with no diagnosis (other than that my wife had aggressive cancer) and no treatment plan.
After hearing nothing on Tuesday we proceeded to our appointment with the surgeon. We stopped by the oncologist’s office and were informed that no approvals had been received from the insurance company, so we could not schedule the PET/CT scan or MRI. The surgeon was great but until we were able to determine if the cancer spread we were in limbo regarding exact diagnosis or treatment. I asked for a copy of all of our records and we scheduled preliminary surgery to install a marker and a central line that will facilitate chemotherapy later. My wife then called the insurance company and the representative told her they had not had a chance to look at Monday’s requests and that it may take 14 days for approval.
On Thursday, we called the oncologist’s office, which told us the insurance company had called Wednesday to get information and was reviewing the records.
I was not sure whom to believe at that point.
On Thursday afternoon someone from the genetic facility called to tell us that because they hadn’t received a family history, the insurance company was rejecting the claim.
In the meantime, my wife attended her pre-surgery consult, and the nurse asked to draw blood. We asked why. She said she needed to perform a number of tests. At this point, the paperwork I obtained on Wednesday came in handy. It showed that all of the tests the nurse planned to conduct had been performed Monday.
The nurse then called the surgeon’s office to clarify, and they asked her for copies of these results.
I was flabbergasted. I had received the blood test results from the same surgeon’s office that was now asking for them to be faxed.
By the end of the day, we had no MRI or PET/CT scan scheduled and no genetic test.
To summarize, a medical doctor ordered tests to determine the diagnosis and treatment of my wife’s cancer. But, we are waiting for an insurance company to review the need. The surgical consult office had no record on Wednesday of tests from Monday, the genetic testing facility does not have the information we gave the oncologist Monday, and the surgeon’s office that photocopied our records on Wednesday was asking for them on Thursday.
My conclusions are simple. If a doctor orders a test, we should trust the doctor and test the patient. Patients should not be waiting for some middle man, whose motive is profit, to make that decision. Records need to be centralized and available to everyone. They should be electronic, and a shared system needs to be used.
I know national health insurance sounds scary, but if you think a big bureaucracy is cold and unfeeling, try navigating our current system. Imagine if you could walk into a doctor, have tests or begin treatments the day you find out that your life is in danger. Is it wise to put at the center of our health care system an agent whose purpose is to profit?
Ben Stuckart, a lifelong Spokane resident, directs a non-profit organization.