June 24th, 2009

Writes Beaver, PA primary care physician Dr. Jay Zdunek, of Heritage Valley Health System and Tri-State Medical Group, for the Pittsburgh Post-Gazette:

In the practice of medicine today, the sacred physician-patient bond is being broken. Health insurers’ cost-driven decisions are overriding the direct relationships doctors have with their patients.

The Post-Gazette’s April 1 story, “Switch To Generic Epilepsy Drugs Raises Flag,” about the practice of switching patients from brand-name to generic drugs, alluded to the role insurance companies play, telling the story of a young epilepsy patient whose doctor switched him to a generic drug “because of insurance.”

But the broader story of how patient care is being compromised in the name of profit needs to be told. Patients’ long-term health often is compromised for short-term gains.

As a primary care physician with more than 20 years of experience, I have continued to watch how insurers’ practices impede physicians’ ability to care for their patients. Our autonomy is being eroded, and my patients, who come to me expecting to receive the treatment we mutually decide is best for them, often leave confused when they are denied that treatment.

Without question, controlling costs is important. But as a doctor, knowing a patient is being denied the best treatment because of an insurer’s decision is troubling.

As insurance companies continue their move toward a standardized care model in which they strive for little deviation in treatment of patients who have the “same” condition, they seem to forget that physicians are not working with widgets. Patients are individuals and medicine is an art. It is not an exact science.

Insurers today can dictate which drugs to use because there is no evidence of significant benefits of one drug over another based on head-to-head trials. Drugs in the same class are generally thought to be therapeutically equivalent because of similar mechanisms of action. So, if you have high cholesterol, you may be prescribed one of any number of generic statins even though they have different characteristics and different patients metabolize them differently. It naturally follows, then, that substantial differences in patient outcomes may be expected.

This is just one example of how insurers are interfering with patient care.

Read the rest of Dr. Zdunek’s editorial at the Post-Gazette.