The Secretary Executives

I strained to keep from rolling my eyes as I looked at Sheila's paperwork.  The surgeon was requesting an inordinate amount of preop testing for a straightforward surgery.  Of course I would clear her, but he wanted me to do a urine culture, chest xray, and protime as part of the work up.  I was well versed in the literature surrounding preoperative testing, I knew there was no scientific data to support this drivel.  But what was I to do?  Tell the surgeon that I refuse and watch as he cancelled the surgery.  I had seen it before.  Reluctantly, I signed the lab and radiology orders and sent Sheila down the hall.

She returned a short time later.  The tech asked her to sign an advanced beneficiary notice, and explained medicare would no longer cover this testing under the guise of preop necessity.  Sheila seeing the possibility of hundreds of dollars of uncovered services, stomped back to my office angrily.  She caught my attention as I was walking a patient to the door.

Can't you find another diagnosis to code it under?  I can't afford this.

I ushered Sheila back into the exam room and explained the sad truth.  No, I couldn't change the code without committing medicare fraud.  No, I had no other justifiable reason to order such superfluous testing.  And no, I didn't actually feel that I needed this information to clear her for surgery.  As she left my office thirty minutes later, I marveled at the teaming exam rooms full of people waiting to be seen. 

Yet again, the primary care physician is the red headed step child of the medical system.

We are forced by specialists to order useless tests without scientific backing.

We are hung out to dry by medicare, and uncompensated for hours of explaining her erstwhile policies.

We have become everything we aimed to avoid,

the secretary executives of a failing system.