Shirah Vollmer MD

The Musings of Dr. Vollmer

Medical Aggravation

Posted by Dr. Vollmer on January 10, 2012

  Lew, thirty-three, has a rare genetic disease requiring pre-authorization for a very expensive medication which he takes by mouth once a month. He switched insurance companies because his wife lost her job, and so now that she has a new job, Lew has new insurance. Consequently, Lew had to find a new primary care physician. This physician has to connect with Lew’s insurance company to state the reason Lew needs this medication, even though Lew has been taking this medication his entire life. Doctor Lippe, a male, newly trained primary care physician, is quite personable and seemingly sensitive to Lew’s needs. Yet, the authorization does not go through and Lew begins to experience vague, non-specific complaints of fatigue, joint pain and headaches. Lew believes his insurance company is to blame, but upon further research, he discovers that his physician never filled out the needed paper work. “You need to get another primary care physician,” I tell Lew, with uncharacteristic directness. “You need a physician who will be your advocate and follow-up with the details of medical work.” I say, sharing Lew’s frustration and aggravation about this critical, although not life-threatening, delay in care. Lew has a hard time understanding my point of view. “He is so nice,” he repeats. “It is hard for you to see that Dr. Lippe might be nice in his office, but the lack of follow-through could be a bad sign for more urgent matters down the road. ” I say, forcefully and unequivocably. “Yes, it is hard for me to see that a physician might be lazy, or not motivated to help his patients, or inattentive to details,” Lew says with uncharacteristic naiveté. “Well, they can be,” I say, with such  obvious frustration about Lew’s poor medical care. “I have to think about this,” Lew says, with agony, partly because he is without his medication, and partly because of our intense discussion. “One issue is that because you did not get your medication, you are in a compromised position to advocate for yourself.” I say, understanding and articulating that medically vulnerable people are doubly hurt because first, their bodies betray them, and second, they are less able to defend themselves against incompetency and unnecessary delays. “Yes, it is hard for me to think straight right now,” Lew says, understanding his vulnerability. “I am so sorry about that,” I say, again feeling the frustration of the health care system.

3 Responses to “Medical Aggravation”

  1. Jon said

    Sad, but true. Primary care physicians are people as well with the trials and tribulations of being overworked. One can be nice and still need to improve one’s attention to detail, especially when another’s health is at stake. Two types of good luck are offered – one to Lew and one to Dr. Lippe.

  2. Shelly said

    I understand Lew but I don’t understand the lack of follow-through by Dr. Lippe. Could Lew schedule another appointment with his doctor and have him fill out the paperwork then? What would be some of the reasons a primary care doctor wouldn’t follow through? It sounds like Lew doesn’t want to leave his doctor. DO you have any other advice?

  3. Shirah said

    Hi Jon,
    I am not sure that primary care physicians are overworked, as much as they have a variable work ethic. That is what I see.

    Hi Shel,
    Dr. Lippe was following through, but not in a timely manner. Yes, Lew could be more assertive, but he is in a weakened state due to his lack of medications. It is not that Lew does not want to leave his doctor, but that Lew does not want to take away his idealization of the profession. My advice to Lew is to keep at it until he gets his medicine. He needs to stay focused on the problem.

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