To the Editor:

As doctors, one of our greatest faults is adapting to our profession’s problems instead of addressing their causes. In essence, we’re treating the symptoms and not the disease. Dr. Jodie Escobedo delegated reviewing and OK’ing prescription refill requests to her staff because it was requiring more than an hour of her time [“Rethinking Refills,” October 2002, page 55]. Physicians didn’t have this problem 10 or 20 years ago. Why now?

More people do take prescription medications these days, but insurance companies are discouraging it by raising co-pays and requiring preauthorizations. We’ve also seen an increase in paperwork intended to improve care, lower costs and reduce liability risk. But at what price?

We can’t do our paperwork between 9 a.m. and 5 p.m. because now we have to see more patients to cover the additional overhead. As a result, we have to hire more help to delegate the refills and authorizations and also to verify eligibility and benefits, make referrals, and bill and collect from the insurers. I could just pack in more patients, but I can’t possibly make up the difference.

Let’s flash to the not-too-distant future: “Mrs. Smith, the nurse will see you now. Oh, Dr. Jones? He went bankrupt and sold his practice to the nurse practitioner.” Think that’s too farfetched? Just sit back and watch. Oh, yeah. I forgot. We’re doing that already.