A Physician's Experience With Patients Who Avoid Tests Until It's Too Late
Avoiding Tests Until It’s Too Late
By Benjamin Brewer, M.D.
The Wall Street Journal
May 30, 2006
Dr. Brewer points out and gives examples of a problem every practicing clinician will recognize – patients who, for many different reasons – avoid screening tests, sometimes with disastrous results.
Especially useful are his observations that
Getting [patients] to perceive a need and spend money and time on something they’d rather not do takes education and encouragement. … For now, salesmanship remains my main tool when it comes to screening tests. Patients need to be aware of what is needed and be proactive in asking their doctor for help.
Tracking is a daunting job for a primary-care office, where we have patients of every age, with multiple conditions of varying severity. It involves integrating results from multiple providers of care. There’s added staff time and expense to manage the process. I don’t get paid for any of the behind-the-scenes work unless the patient comes in for the test. After figuring in staff time and computer costs, I’d be lucky to break even when a person does come in for screening. Some insurers pay for screening, some don’t, and some do only for certain conditions or certain time intervals. … with the exception of a few pilot programs, commercial insurers, Medicare and Medicaid don’t cover this added work outside of the traditional office visit. … If insurers want to compensate doctors based on performance, they can expect some doctors to drop patients that won’t come in for follow-up or recommended screening tests.
Dr. Brewer’s views point toward my own contention that implementation of treatment plans, including participation in screening programs, is unlikely to significantly improve until there is an alignment of all healthcare stakeholders – clinicians, patients, healthcare systems, and payers.
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