Referrals sustain buddy system

Dear Dr. Gott: This morning’s newspaper had your article concerning the internist who would not treat the sore throat but simply referred the woman to a throat specialist. She paid the internist $61.90, but I guarantee you that the specialist charged another $125 to $200, depending on what part of the country she lives in.

I, too, depend on an internist to be my primary physician. My sister also uses this doctor. We call him Dr. Well because he treats us only when we are well. If we have any illness, he immediately refers us to specialists.

Sometimes I bypass him and make my appointment with the specialist if I can wait several weeks to see him. But, if I am really sick, I must get to the internist and let him call on the phone to get me in to see the specialist the next day.

It is really a big buddy system. They refer sick people, and each of two or three doctors makes a fee off the sick person.My age is 77, and my sister is 80. We have lived long enough to know when we’re getting messed over.

Dear Reader: Your letter is representative of many I receive. Some criticisms are valid, many are not. Yours may need some explaining, because your primary-care physician could be a victim of an insurance company. In such an instance, the company will not pay for a specialist’s office call unless the patient is referred by a primary care provider. Yes, the doctor could have examined the woman briefly, ordered a throat culture and suggested that she gargle with hot salt water, but that’s not how the system works now. In today’s medical climate, referrals are the rule. Does this drive up medical costs? Yep, in spades. Is it good medicine? Rarely. Will the system modify its policies to reduce duplication and overspending? Unlikely, as long as the chief executive officers continue to pull in multimillion-dollar salaries for basically – as you pointed out – messing over the insured, as well as the doctors, for whom a routine office (or home) call is ridiculously underpaid.

I compliment you on being feisty. My patients who are feisty seem to live longer and more independently. However, neither you nor I have any say about the direction basic medical care will take in the next decade or two. My impression is that it will be a downhill slide into bureaucracy, the exact opposite of the image I embraced as a medical student more than 40 years ago. Am I a curmudgeon? Probably, but it keeps me going.

I am honored to receive mail from interested readers and am eager to respond to questions and concerns. Unavoidably, this also includes complaints about the direction medical care is taking: a technological revolution in which patients are simply “cases” and medical attention is governed solely by administrators who are not medical doctors. In some instances, but not in all, this is a buddy system, as you concluded.