The P and M Words: Easier Said than Done

Yesterday brought two excellent and interesting conversations, both of which could directly affect your medical care.

First, my news alerts sent me to the website of a family practice physician turned patient advocate, Dr. Delia Chiaramonte. I wonder if the people in Baltimore, MD realize what a gem they have to help them?

Dr. Chiaramonte is unique in that she has all the credentials of a physician, but is now working in a patient mind-set. Now I realize that sounds strange; afterall, don’t all physicians work in the patient mind-set?

That would be a no.

She is doing exactly what I asked about when I blogged several days ago about finding patient advocates. She is providing that umbrella service that pulls together all the necessary records and synchronizes the patient’s care. She’s the maestro of the patient care symphony.

That’s the M word: MAESTRO. She’s doing exactly what most patients think their primary care doctor does for them — but doesn’t – because PCPs don’t have the time or the ability to get paid for that synchronization.

And she had to get out of the doctoring business to do it.

She also was able to enlighten me on something I didn’t clearly understand before — key to the understanding of patient empowerment. She explained to me the concept of angry patient; the patient who expects to deal with a doctor who won’t do what s/he wants the doctor to do. (Doctor, you need to prescribe for me Drug X, which I saw on TV, because I know my health will improve!) — vs — the concept of “ego-dystonic” — meaning — a doctor who thinks he is superior to the patient, but comes into contact with a patient who won’t treat him with the reverance he thinks he deserves. What happens when you put the two in the same room can only be described as… well… frustrating at the very least, and sometimes even explosive.

Clearly — those personalities and approaches will never form a partnership. That’s the P word — PARTNERSHIP! As you know, I continually advise patients and doctors to collaborate, to partner in their decision-making.

Patient empowerment is about that collaboration — not about anyone acting superior to anyone else. And when angry patient and ego-dystonic doctor come together, any chance of partnership is unlikely.

Conversation number two was also invaluable and just as enlightening. Dr. Michael Victoroff is the Chief Medical Officer of Lynxcare in Denver, CO. Like Dr. Chiaramonte, Lynxcare provides similar patient advocacy / “clinical advocacy” services (Dr. Victoroff’s description — I like it!) to patients who need that big picture view of their medical problems in order to figure out what to do next.

Dr. Victoroff has this incredible body of work and experience — not just in a patient/clinical setting, but with myriad boards and committees and “inside” the system work. He seems to have seen it all.

What he explained to me was the concept of medicine by code. As we all know, when we visit the doctor, everything is coded — from basic office visit codes to testing codes to surgical codes — everything gets a 5-digit number based on the CPT, Current Procedural Terminology, code which is developed and issued each year by the AMA, the American Medical Association.

One of the biggest uses for the codes is by insurance companies so they can reimburse providers for their work. Doctors have to choose a code for everything they do for a patient. That code gets submitted to the insurance company, and the insurance company reimburses the doctor for the coded service.

According to Dr. Victoroff — and this is just so d*mned logical! — the reason doctors can’t do much of what we wish they would do, is because there is no code for it. Ha! The light goes on!

So, whereas I have been questioning why doctors won’t step back to look at the big picture to help patients — why they won’t be the maestro for the patient care symphony — the answer is as simple as a 5-digit number. There is no code for it.

Which means — that P word — PARTNERSHIP — ones again takes a hit. There is no code for partnering with your doctor. And there is no code for the M word — MAESTRO-type services, either.

Geeez. Talk about banging your head against the wall. Maybe we need to take on the AMA?

A lot to learn on a Thursday in July, wasn’t it?

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Trisha Torrey
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