In all businesses there are, to be blunt, the schemes to make money. Strategies to increase profits and these strategies are always at the expense of the consumer. When we think of the medical profession, we typically forget that we are consumers and doctors run businesses. When we see doctors, we are singularly focused on feeling better and less focused on the doctor’s profits or bottom line. If we have good insurance paid for by our work, we typically stop thinking about the cost of medical care all together as it is almost invisible to us. We may only encounter the business end of our medical care with a co-pay of some type. Then we forget. If you have a chronic illness, you are seeing so many doctors at any given time, you can’t help but notice the money changing hands. Usually it’s happening so much, it’s an unavoidable aspect of our medical care. And in many instances, particularly if you have Medicare and no supplement (if you are like me, you are too young to have a quality supplement and the ones that are available are too costly), you are paying bills after the appointment for what was unpaid by medical insurance. But there is another way doctors manage to wrangle a few more dollars from you and in such a way as to play on the idea, not the fact, that they actually care about you personally and know you well. (While most of my doctors I’ve seen for years, know me very well, most of my other specialists know me only by face, not by name.) This seemingly innocent strategy is denying refills of your medication.
Today, I made one of my many trips to my pharmacy--they do know me by name and even know my birthdate now, despite being a big chain. I was told that one of my doctors who prescribes my Alfuzosin denied the refill without an appointment. So at first thought, you might say: sure that’s good medical practice; he or she wants to make sure you are doing okay on the medicine. The problem with this as the first thought is it is a surefire way to losing money. Your first impulse is to call the doctor and make an appointment. You’re willing to pay the copay for the visit to get the medication because the doctor has your best-interest at heart. Sometimes that thought is logical, but only if you are on a new medication and the doctor needs to assess how you are doing; to touch base with you to make sure you are improving and not having side effects. They need this for their records and liability risks, and usually the patient needs this to feel reassured. I’m all for it. But then you become a source of income and it goes something like this:
May 2017 I saw my urologist for a follow-up. Due to the strokes and SLE progression, I have some paralysis of my bladder making urinating hard to do; I take a medication that stimulates bladder contractions so that I can urinate. It’s an important medication. Urine retention can be fatal untreated--it’s just one more of those health issues I have that carry the label “fatal if untreated by medications”. My urologist is good. He’s also a very sardonic kind of guy. When I first met him he said to me I have a medication list like an 80-year-old lady in poor health. He’s one of those doctors who is what I call a WYSIWYG--what you see is what you get, he doesn’t make much attempt at being a doctor. He complains to you about his work, he makes sarcastic comments, he’s upfront about how little time he has with patients, etc. So when I last saw him, he said, “I will see you in 2018, no need to see you sooner.” Why? Because I have to be able to pee. The medication works. I’ve been on it long enough to no longer have major side effects. I’m a stable, boring patient at the moment in his eyes. But here I am unable to fill a medication I need, will run out of sooner than I can get an appointment with an over-booked doctor, when I shouldn’t even have to see… But he works for a larger medical group. And they have their own policy: make money.
So when my pharmacy made their routine call for refills. A receptionist or nurse told them I need to come back in, when the doctor doesn’t need to see me. And in all truth, I don’t have the money to waste on appointments that are medically unnecessary. But I will have to call and make that appointment because Doctors have something no other business holds in their hands: our lives. And so my money will go out the window.
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