Mar-Apr 2010 Table of Contents

THE LAST WORD

An Open Letter to All the Health Plans That Keep Sending Me Letters

How helpful are all those letters you receive from health plans? Not very, says this family physician.

Fam Pract Manag. 2010 Mar-Apr;17(2):52.

Dear health plans:

I am writing in regard to the many letters that you send to my office each day with messages such as these:

  • “This member reported the following issues, which may require further investigation: depression/pain.”

  • “We would very much appreciate your review of the enclosed list of patients identified as having atrial fibrilla-tion for possible use of anticoagulation treatment if they are not already receiving such.”

  • “Your patient, Sigmund J. Doe, has not refilled his prescription for antidepressants in two weeks.”

Sometimes your data is accurate; more often, it is not. But thank you for sending me little bits of medical information that you think I must not know, such as “Warfarin dramatically reduces the risk of stroke in non-valvular atrial fibrillation,” or “Here are some symptoms of depression … ”

You may be surprised to learn that these concepts are not new to me. They were touched upon during my four years of medical school and three years of residency. If my patient hasn't refilled his depression medicine, it's not because I haven't yet gotten the news that depression is treatable or that treatment should be continued for at least six months. It's not because I haven't told my patient these things. I say them every time I prescribe an antidepressant.

Perhaps my patient didn't fill his prescription because I gave him samples out of my sample closet. Or perhaps he hasn't yet filled it because life is chaotic and sometimes a trip to the pharmacy doesn't happen in time, or because he's having side effects and doesn't want to bother coming in again, or because he's having financial problems and can't afford to refill his medications. Or maybe he isn't taking his medication any longer because he's feeling better and, even though he knows he ought to continue, he doesn't want to take medicine every day.

And maybe the reason I haven't called him at home to talk about his antidepressants is not simply that I'm a lazy, uncaring doctor. I have 28 lab tests to review, 15 refills to process, five patient questions to answer by phone, four pharmacy requests for non-formulary medications to complete and a disability form to fill out – in addition to the 21 patients I saw in the office today.

I want to do better for my patients. I want to be sure that I have reminded everyone of needed preventive tests. I want to delve into the personal problems that keep my patients from controlling their chronic medical problems, and I want to help solve the major and minor acute problems that brought them into my office in the first place.

Your letters don't help.

If you'd really like to help, stop deluging me with unnecessary and duplicative paperwork and administrative tasks, and start paying for the burdensome non-face-to-face work required of family doctors.

About the Author

Dr. Lundeen is in private practice in Oxnard, Calif. Author disclosure: nothing to disclose.

Send comments to fpmedit@aafp.org.

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