Determination Of Need

I have come to terms with making difficult decisions.  I accept  the possibility of committing a mistake that will cost a life.  But I never signed on to bankrupting my patients.   Never!

I had been up all night tossing and turning.  The stat cat scan was deemed unnecessary by the insurance company.  My patient called crying saying he couldn't afford the thousands of dollars in charges.  Never mind the fact that the results suggested two life altering diagnoses.  Feeling horrible, I called the hot line immediately and was told that the consulting physician would not be available till the next morning.  Meanwhile, my patient was set up for an emergency consultation with the appropriate specialists.

My blood pressure began to rise the next day when my staff was still unable to reach the appointed doctor, the judge and jury deciding my patient's economic fate.  I replayed the decisional process in my mind.  Of course I could have done a chest xray and an ultrasound first.  But given the acuity of the symptoms, I didn't feel like I could wait.
And indeed, the scan did exactly what it was meant to.  It answered the pertinent question and allowed for immediate, possible life saving, action.  But as I finally picked up the phone to argue my case, I felt my heart beating out of my chest.  If I didn't perform, if I didn't say the right things, my patient would be saddled with unmanageable debt. 

My vocal cords shaking, I answered the questions as best as I could.  The businesslike voice on the other side of the line was steady and devoid of emotion.

But why a Cat Scan?

I again described how the acute shortness of breath, abdominal pain, and surprising physical exam mixed with the recent history of cancer was troubling.  I waited in between long pauses for a verdict.  Eventually, I was told that the interview was over.  Helplessly, I sputtered out the question that rested so heavily on my brain cells for the last twenty four hours.

So are you going to cover it?

Impatiently,  he explained that he wasn't able to give me a determination over the phone.  The nurse coordinator would call my office back.  As the words left his mouth a female voice chimed in who, unknown to me, had been monitoring our conversation.

Thank you Doctor for your time.

A few minutes later we received the call telling us that the cat scan would be covered. 

This time. 

I breathed a sigh of relief.  Now, I could go back to dealing with the fact that his life and health would never be the same again.  He was my next appointment. 

It was time to break the news.