Sunday, September 16, 2007

Health Insurance

My new practice does not take health care insurance. I have spent the last two years taking health care insurance and in a word it has been mostly demoralizing. The expectation by insurance providers (or maybe a better word is demand) is for psychiatrists to see patients for subsequent visits in 15 minutes or less. This is a unrealistic and apart from saving insurance companies money for services needed, it is ridiculous. I have prided myself in spending as little time with patients as necessary for their care to reduce costs. It has almost never been less than 15 minutes unless rare circumstances occur. Years ago while doing research into Seasonal Affective Disorder, our rating scales to assess progress or not in patients, took at least 20 minutes. Our research was to measure receiving a specific intervention for the condition or not. I did my best to not provide talking therapy in those studies so the patient didn't receive two interventions at the same time, confounding the results. Unfortunately, it became abundantly clear to me that physicians with expertise and patients with problems that went beyond medication or light therapy in this example, would still receive it. Confronted by a person who's dog had just died, needed the support required and I did my best to help the person first, even though it confounded the research to some extent. It is impossible to just provide medication or surgery without the talking therapy, even for health care professionals that don't realize how helpful their comments are. The same is true of psychiatrists writing prescriptions for patients with mental health problems that are also being seen by a talking therapist or not. Something comes up in the persons life since the last visit and it can't be ignored by the doctor. When it's ignored or referred elsewhere, it is seen by the patient as insensitivity or lack of caring. Neither augments the doctor patient, the foundation of all interventions. Research is clear, the more a person seeing the doctor trusts and likes the doctor, the more likely they will comply with other interventions like taking medication. 15 minutes is simply not enough time for a therapeutic exchange to occur and that is why I don't work with insurance companies in my new office in Rancho Santa Fe. Some people may have to pay more up front, although the more effective treatment is worth it in the long run. A small increase in time with a person in need, provides more comprehensive care and ultimately costs less in the long run. If you think otherwise or agree, let me know by posting a comment. Thanks.

1 comment:

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