Printed By the Coral Gables Gazette

Over the past months we have discussed HMO=s, capitation, gag orders on doctors, gatekeeping, Least Expensive Professionally Acceptable Treatment versus Best Available Care, and how this type of insurance literally means that the more treatment you receive, the less potential profit your doctor or hospital realizes. The potential for this fact to change the relationship between patients and doctors from one of physical to fiscal responsibility is alarming. Today, more than ever, your health depends on the integrity of your provider.

The burning question must be, AHow does the patient determine the quality of his or her health care?@. The definition of quality in any service is difficult, and in a service based on technical knowledge and skills, the lay person may feel unempowered to make such a judgement. However, as with many difficult issues, some basic and indelible benchmarks do exist by which to judge the quality of your health care. The following list is my opinion regarding basic rights of medical and dental patients which should never be compromised:

1) Prompt Attention to Emergencies- true emergencies involving pain, bleeding, adjustments of life-saving medications, and evaluation of significant symptoms or side effects- should receive attention on the same day that they are brought to the doctor=s attention. In fairness to the doctor, minor aches and inconveniences may be attended to at a more convenient, but reasonable, time (say, within a week). When a doctor is out of the office, a means of emergency contact is absolutely required and a doctor of similar competence and training should be on-call. Beware of doctors leaving emergency rooms on call without any intermediary.

2) Answers to Your Questions or Concerns- you deserve to have all of the information that you desire to make your health care choices. You have the right to know if your plan has placed your doctor under any gag order or restrictions limiting his or her ability to fully disclose all available options to you. You have the right to reasonable information about your medicines and procedures. You have the right to second and third opinions from doctors independent of your plan, although these may be at your own expense. In fairness to the doctor, some of these discussions may take place after office hours, but don=t allow yourself to be ignored.

3) Timely Care- how doctors manage their practices may be a reflection of their values. You should not routinely have to wait more than fifteen minutes past your appointed time to be seen without explanation. In fairness to the doctor and other patients, emergencies do happen and deserve proper attention (next time it may be your emergency!), but the manner in which these instances are handled speak volumes about the quality orientation of the practice. Preventive care should be respected; for example, you should be able to schedule a dental cleaning within one month of your due date. Offices which belittle the importance of prevention in lieu of urgencies and emergencies should be considered suspect.

4) Relationships- you deserve to have a doctor who treats you with the same attention and respect as a revered family member. The old fashioned Adoctor as god@ presentation is over, but you should feel that your doctor is approachable and personally invested in your well being. If your patient experience has left you feeling like a piece on an assembly line, then you probably have a less than attentive doctor.

5) Results- after being educated regarding the nature and possible consequences of your health problems and treatments, you deserve to get realistic results. These will differ according to the specifics, but your ongoing treatment results and explanations of any deviations from predictability must be satisfactory to you. You must understand and accept that, despite a doctor=s diligent efforts, poor results do occur. However, outcomes should be explained in an understandable and satisfactory manner, and any further alternatives explained.

Armed with this Patient Bill of Rights, what are some specific warning signs for a less than satisfactory level of care? The following is a list of situations, which in my opinion, are contrary to your above mentioned Rights:

1) Doctor Who?

On many plans, the doctor you sign up with is not necessarily the one who treats you. You often get the associate (employed doctor), who has little or no long term stake in the practice.

2) Access Limiters

Some doctors ascribe limits or ration access to certain plans. AThis plan is such a loser that we will only schedule two patients a day.@ You may wait three to four months for your thirty minute dental cleaning.

3) Artificially High Usual Fees

Like many retailers, some plan doctors inflate their fees so that the plan only seems like a discount.

4) Double Standard

Doctors on reduced-fee plans often use less expensive medications, supplies, and vendors for their plan patients. Some plan dentists use budget or third world dental laboratories. Thus, you don=t receive the same care as full-fee patients.

5) Robin Hood

Doctors on reduced fee plans must often charge their non-plan patients higher fees to make up their financial difference. This is grossly unfair and contributes to the higher overall cost of health care.

6) Bait and Switch

Doctors sometimes sell optional treatments that require additional out of pocket expenses. AThe treatment you need is unfortunately not covered in your insurance contract. You really need this help, and you must pay for it yourself.@ It is very common to find multiple exclusions in dental plan contracts. If you are paying out of pocket for desired treatment anyway, why not do so with the doctor of your choice?

7) Time Bandits

Doctors on reduced-fee plans often make up for their loss by decreasing the time spent with their patients. No time for questions. No time for a cancer screening. Attention is focused on the complaint with little time spent on the whole person. The average contact time with a physician in this country is now about five to six minutes. That doesn=t leave much time for education and thoroughness.

The bottom line is that quality in health care is only as high as what you demand. You vote with your choices: choice of plans offered, with your choice of doctors, and choose to provide feedback to your employers.

What do you do if you find that your plan does not satisfy your own values and quality requirements? Your first step is to let your benefits manager know of your dissatisfaction. The next step would be to research other doctors and consider a change if you get good reports. For medical care, with its potential multi-digit costs, you are urged to work with your employer to execute a change in your choices as quickly as possible. For routine medical care, many patients prefer to see their doctor of choice and pay out of pocket, and choose to see their plans as no more than a modern type of Amajor medical@ plan- for disasters only.

For other types of health care, such as dentistry, the average annual patient expenditures are much less (and the excluded treatment lists are so big) that many patients are actually saving money today by dropping their dental insurance and investing that premium into treatment with their trusted dentist of choice.

I urge you to remember that Value is the sum of Quality and Acceptable Cost. Don=t forget to measure the quality of your health care at every visit.

 K. Randall Groh, DDS, is Acting Chairperson
of the American Independent Dentist=s Association,
an organization dedicated toward maintaining quality in health care,
and is a practicing dentist in downtown Coral Gables.