Dialing a doctor

Some relationships can’t be nurtured over the phone

WILLIAMSVILLE — I recently received a phone call from a registered nurse hired by my health insurer, hoping to enroll me in Blue HealthSolutions, a “series of health programs available to members at every stage of life.”

This woman had a warm, Southern accent; she wanted to tell me how I could use her and her colleagues to manage my chronic health problems, about which she seemed to know quite a bit.

Thanks to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which is euphemistically called a privacy law, my insurer has the right to contract nurses all over the country to talk to me about my personal health information. These nurses are available to me by phone at any hour of the night or day, and wouldn't I like to sign up for this service?

I thanked her as politely as I could, telling her I'd rather discuss my health care with my doctor, locally, in person.

As inevitably happens when I have any phone contact with my health insurance company or its proxies, my blood pressure went up.

Really, all I want my health insurance company to do is pay for my covered medical care, not provide it.

I especially don't want to be treated by someone in another part of the country by phone. I want to be treated by someone who knows me, right here in my own community.

But sustaining a long-term relationship with a local primary-care doctor is getting harder, mostly because health insurance companies like mine don't pay doctors enough to stay in the business of providing primary care. Even though primary care is the most cost-effective medical care available, insurers still don't pay these hard-working physicians enough to stay in the field.

In the past 28 years, I've had five different primary care doctors, because one retired and three left clinical practice in favor of shorter hours and better pay.

I've been seeing my current family practitioner for just over a year, and even in that short time, she's switched from running a solo practice to joining a larger, salaried, group.

The complexity of medical billing makes running a solo practice an expensive enterprise, and the insurance companies typically and routinely underpay primary care providers so that it is nearly impossible for a primary care physician to run her own practice these days. And this has implications for patient care.

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Asking for and receiving health care is an intimate exchange of information, and the choices to test and treat varying conditions have significant implications for the patient - that would be me.

These are not issues I want to discuss with strangers, living in another part of the country, over the phone. No, I need a face-to-face relationship, based on respect, trust, and knowledge, to follow through on the two most important - and cost-effective - avenues toward good health: health maintenance, and care of chronic disease.

Without a doctor I could trust, I'd have only vanity to keep me from eating Cheetos to achieve a content obesity, and I'd easily turn into a couch, a potato, or both.

But one of my physicians taught me about body mass index, which triggered my competitive streak to get mine down to 25. My doctors have also helped me make sense of my routine blood tests, explaining the relationship between ebbing hormones and rising cholesterol.

Despite my now-healthy lifestyle, I'm aging, which puts me at risk for certain diseases, like breast and colon cancer, which are treatable if detected early by fairly unpleasant diagnostic tests.

Based on the relationship I'd developed with the doctor I had when I turned 40, I overcame my reticence to undergo a mammogram and signed up for one.

It's not just that I'd been told that a mammogram was a lot like lying naked on a cement floor in winter and having a friend drive a truck over my delicate parts, it was also the fear of finding out that I might be harboring a cancer.

I don't think a stranger could convince me by phone to sign up for this information, but a doctor I trusted to be there for the results could convince me of both mammography's pros (early detection, swift treatment, and a good prognosis) and cons (“C'mon, Deb, it's just a few minutes of discomfort!”). I'm now a 16-year veteran of the procedure, and it isn't that bad. Really.

Having a doctor I trusted when I turned 50 gave me the courage to comply with the medical recommendation to have a colonoscopy. I didn't actually mind the test itself because I had good drugs and don't remember a thing, but the preparation for it isn't something I'm eager to repeat. And I don't have to - until I turn 60.

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Encouraged by my primary-care doctors, I've become what is known in the medical field as a “compliant patient.” This means that I follow medical advice.

But not blindly. Because I have developed trusting relationships with my doctors, I've been able to voice my fears about some recommended treatments for the pair of chronic illnesses I've picked up as I've aged.

I'm a child of the “natural is better” and “less is more” movements, so it's been a big deal for me to agree to take medicine on a regular basis. But when it became a choice between medicine and breathing, I learned to take my meds.

The nurse from Blue HealthSolutions wants me to take them 365 days a year, but she's reading from a script for treating one-size-fits-all allergy-induced asthma for people in California as well as Maine.

My doctor and I both know the allergens that trigger my condition flourish at very particular times in New England, so that's when I medicate. Ironically, this tactic keeps me breathing and saves my insurance company money.

In short, it works even though it does not follow the cookie-cutter standard of care.

Talking me in to taking medications for my cardiac profile was a much-harder sell, and it was hard even for the doctor I know and trust.

There's no way I would have agreed to do this with a stranger, by phone. Only by thoroughly discussing the pros and cons, my family history, and the failure of my now-healthy lifestyle to change my genetic predisposition have I succumbed to treat an invisible disease.

Because I'm good about health maintenance, I don't cost my health insurer a lot of money. And I'm good about health maintenance because I have a trusted, local physician with whom I can talk with face to face, and who can lay hands on me to do a physical exam.

How is a nurse from Blue HealthSolutions going to do that over the phone?

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