Is It a Choice?

The research coordinator sat next to me and said “his insurance will only approve a phase 3 or phase 4 trial, and while this trial you are offering him is a phase 3 they have denied it anyway!” Frustrated she also added “we are in the process of appealing this, but it could take up to 30 days.” I stared into the cubicle I was sitting in. I never check which insurance company a patient has nor do I understand the “what is allowed or what is not.” I had met my patient a week ago and I counseled him with options that I felt would best serve his treatment and his goals. How do I explain that his recommended treatment is off -limits due to insurance, and we need to consider an alternative? Why should I? I honestly did not want to.

I have practiced medicine in many different systems. In Jordan, recommendations for treatment are often coupled with a price tag. It is one of the big reasons why I do not practice there, and feel that a health care system does not need to discriminate in care based on a patient’s financial abilities. I have blogged about this hindrance previously and I do this again as I feel passionate about patient care and where it may be heading.

In the modern health system of seeing patients in 20 min, we have to discuss an incredibly difficult and complex disease in the matter of minutes with our patients. The industry of medicine has truly become too demanding and very bulky. From a physician perspective there is a need to understand the exciting number of breakthroughs in cancer research at the same time present unbiased informed consent to patients explaining treatment options and offering a true reflection of what knowledge is out there. This is coupled with an explosion of technology, electronic medical records systems, the almost immediate availability of information, test results and expectations. The physician now faces the dilemma of appealing denied insurance claims to render his decision for the selected treatment “allowable”.

Patient’s choices are limited by which insurance they belong to which clinical trials are available to them for cancer care. It’s the art of medicine to help the patient navigate such hard choices and ensure a good decision is made. I am a believer that everyone should have health insurance, however in our system it appears that some are better than others reminding me of the novel “Animal Farm.”

My patient looked at me and said, “I want what you think is best for me in the treatments you have outlined for me.” This is a huge responsibility to walk a patient through a network of decisions influenced by the many changes taking place around us, yet we are being asked to do this in a very short period of time influenced by the politics of insurance companies. So I am left with a simple question today as I blog, is it a choice?




5 thoughts on “Is It a Choice?

  1. From a client perspective the insurance industry in this country is a mess. From a provider’s perspective I can only imagine the daily frustration and headaches that run rampant. Unfortunately I only see a continued degradation with very few bright spots. I was once diagnosed with Stage 3 melanoma but unable to get treatment at that stage. Now at Stage 4 I have many more options (thank God) but the question of why I needed to be at Stage 4 to become eligible. Not to ramble, but I appreciate the insight from a provider’s point of view, even if it is only a moment of frustration that is recorded on WordPress. Thanks. – Justin

    1. Drugs go through a rigorous process to be approved. Clinical trials are done in a way to make they are safe and effective in delivering care. More options exist in stage 4 disease because we are trying to find agents that will impact stage 3 disease. I hope my answer sheds some light.

      1. I would argue that the staging approval process for clinical trials works great on paper but leaves potential “wins” out the door in reality. As with any other system it is clearly imperfect.

  2. Mo,
    The health care system in our country is so messed up and I am one of the lucky ones,I have great insurance and cannot complain. I’m sure you feel like a little spec being involved in this maze of confusion of the politics of the insurance companies. It is a corrupt system for sure, but Mo if it wasn’t for a doctor like you and for compassion for your patients we wouldn’t stand a fighting chance. I am so lucky and greatful I have you for my amazing doctor of science.
    All your patients love you Mo so keep fighting for our choices.
    Your favorite fan,

  3. * Dear Mo

    your blog brought some perspective to my life. I am counting my blessings:

    1- I have insurance that covers xxxxxxxx’s treatment 2- I have a doctor who cares about his patients and don’t care to be called a doctor 3- I have in you a friend 4-I trust you

    I am truly blessed


    Ricardo Saban, DVM, PhD Professor Emeritus of Physiology, College of Medicine, University of Oklahoma Health Sciences Center (OUHSC) Visiting Professor, Department of Neurosciences, UW-Madison Home: 3707 Signature Drive, Middleton WI, 53562, USA Phone 405/802-2316 Email1: Email 2: ________________________________

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