The Demise of Medicine

Dear Doctor _____________,

A week ago I read an article in The Philadelphia Inquirer about the extreme negative impact of insurance rules and red tape that is making the practice of medicine outrageously arduous. As a response to this article and as a response to my observations made during my life as an eight year metastatic breast cancer patient I wrote a letter to the editor of The Philadelphia Inquirer which has apparently not published. Basically, I stated something like the following.....

"I have been a patient with a serious disease for eight years and during that time I have watched as the practice of medicine has degraded from an experience where kindness, patience, knowledge and compassion and collaboration generally ruled the day to very rushed, harried, splintered, highly delegated practice. I have watched as practices have grown and grown to the point of bursting, hiring more and more people and never creating the highest quality care they had at the beginning, in spite of great effort. I have been told (and I believe this is true) that this very exponentially changing situation (it has gotten considerably worse in the last months) is due to the extreme and ever changing red tape that is created by the insurance companies. I wonder why such red tape has to exist for patients with such serious diseases? As one of my brain surgeons stated in frustration, 'I don't know why I have to pre-certify a brain MRI for a patient with known brain cancer ' "

"I recently visited an office that did not take insurance with my son. There was no waiting, there was no hassle. The doctor examined my son for forty-five minutes and answered all questions. He was truly acting as a physician. I teach pre-medical students many of whom immediately enter medical school. I have never heard one state she or he wishes to be the manager of an outrageously stressful business with little or no patient care. No, they emphatically state the ideals of wishing to altruistically work with patients. The speak of it passionately and seek service work along these lines. Obviously, insurance is needed in cancer clinics and the like, but I do not understand why getting the drugs for essential, life saving and life lengthening treatments and the scans needed to establish these treatments require such ridiculous and ever changing policies. None of this is good for any one, least of all the patients."

I hope you know my doctor, that I wrote this in support of you and others, but especially for you and your collegues. You sometimes seems so overburdened with these issues and so different from the person I met eight years ago. It breaks my heart and though you may not believe it, I feel great empathy toward you.

I long to help. I have tried to help and obviously succeeded at nothing, but I want to help you. I want to make medicine better. For you because you have worked so hard to lengthen my life and just for all the times you went above the call of duty. I want to do it just as much for the other patients who need a doctor of your experience, knowledge and work ethic. You told me when I was first a patient that I was am integral part of the treatment team and I need to continue the collaboration to survive.

But beyond that, I see the demise of the medical system in these problems. As you know, I spent the better part of a year wrestling with a large insurance company, even meeting with the vice-presidents. I read up on the law and learned about how these companies are essentially immune from lawsuit due to the inability of wronged patients to sue them in the state courts.I argued with them, had thousands of people write and to little avail. I went up to the high towers of the huge insurance giants and sat and argued. I prepared for months. I thought if they heard the appeal of a real cancer patient they would listen, but they held steadfast that there systems they had created for you and other doctors were easily learned and extremely simple to operate. But clearly they are not. I see nothing but tension and people racing around.

I am writing this to tell you that I know it is terrible. That I want to do something. I know I have failed at this. I know this is because when I worked hard to get the herceptin coverage back for all the patients with metastatic cancer at your office, the insurance companies told me that we need not worry because our physicians will take care of our problems. But, when we go to our physicians they are not ammenable and tell us many things can't be done and they are not willing to try. I know the insurance companies send us unintelligible forms that show the tentative approval of the coverage of tests and scans (but we can't readily tell which test or scan). When I have directly tried to induce change they have done this. I find patients don't get it and the insurance companies know it. I liken it to the dark ages where the Mass was said in Latin and the peasants were kept completely ignorant. It is a form of power. The insurance companies have said to me that no one complains. The governors office of the state of Pennsylvania told me that only two or three people/physicians complained about the insurers in one year. I got no response from my representatives - state or federal. I even wrote presidents.
I tried and tried and tried and tried.

But, I stil feel passioniately about it. I know I have survived a long time with what was initially defined as a terminal, incurable disease by becoming highly knowledgeable and in large part by collaborating with you on medical issues, by knowing you. I think of today and how quickly we got through issues and arrived at a different way of dosing my etopside. It was the collaboration of two people who know each other and can communicate quickly.

I meant you no disrespect when I asked you why things were getting worse, why you seemed so harried. I really did not, I just could not help noticing it. I hope you know I think of it all the time. I am not an ungrateful patient who believes that my healthcare is easy or my right or anything like that. I feel privledged to be you patient and I know the good doctors are going to leave and the new doctors are going to be dismayed. You are right, the insurance situation is going to ruin the medical system and yes, kill patients.

I vow to you that I will keep fighting to make it change and to make others understand this life threatening disaster that makes your work so overwhelming and relentless. The extreme power of the insurance companies have to be broken , they have to cease acting as physicians and put the patients first.

as always, sincerely, your patient, Mary