Monday, January 11th was one of those days.
"Mrs. Eldon said that you rushed out of the room without writing all of her prescriptions."
Andrews immediately visualized the elderly woman in exam room three. She always seemed to have all the time in the world. Certainly, much more time than he had. Worse yet, she routinely arrived with a plastic bag filled with paper scraps on which she had scribbled questions. She always insisted upon reading each question aloud to him, one at a time--resisting his efforts to scan the questions himself, which would have been quicker. She also claimed that her questions were far too important to discuss with a nurse. He had yet to see why.
"Mrs. Eldon also wanted to know why the phone call you took during her appointment was more important than her problems."
Actually, it had turned out not to be. Andrews had wasted five minutes arguing with a pharmacy over a demand that he fill out some two-page fax form immediately, simply so one of his patients could fill a single prescription that he already had written the week before.
Immediately thereafter, as he was walking back to finish up with Mrs. Eldon, he was waylaid by another of his employees: an insurance clerk who was beside herself. As usual, her problem involved MaxCare One, a new HMO. Unlike the other third party payor organizations with whom Andrews had enjoyed a longstanding, cooperative and mutually beneficial relationship, MaxCare One instead seemed intent on erecting frustrating barriers to the delivery of good care.
Now, Andrews was told, it had failed to preauthorize a medically necessary procedure scheduled to be performed later that same day...despite the fact that authorization had been requested some fifteen days ago.
Andrews was furious. It wasn't the first time that they had dropped the ball. Furthermore, that particular HMO's medical director routinely refused to return his calls. Thus, he next wasted yet more time by berating an HMO representative on the telephone. She attempted to lecture him on what tests were warranted for that patient's illness. She couldn't even pronounce the name of that illness correctly: which increased his anger. For all he knew, she may not have been housebroken--and he felt like telling her so.
Damned MaxCare One. The whole scenario was ridiculous. He resented being told how to practice medicine by MaxCare One clerks whose last jobs may have been in the fast food industry. Because of that HMO, he was having to scramble to see more patients per day. At the same time, his income had dropped and his overhead had increased. He realized that as a gatekeeper, he was having to pay his own employees to perform MaxCare's "scut work".
He scribbled the prescriptions quickly and instructed the MA, "Tell Mrs. Eldon to write me a letter about the rest of her questions." He then looked at the flag by room one.
"What patient is in there now?"
Andrew' stomach churned. Swell. His practice was in good part dependent upon MaxCare. They had low-balled their rates to the point that most of the major employers in the community had contracted with them. He didn't see how he could survive without them...as hard as it was to live with them. While he despised their high-handed tactics, to be terminated by them would probably prove devastating.
"Cool down,", he told himself. He grabbed Waxman's chart out of the bin on the door and pushed it open after a hasty knock, trying to force a smile that he didn't feel.
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