QUALITY: PC Load Letter #@!?!

Our uncle Rich—who for our 21^st birthday gave us his law firm's card—once told us that the only people who hate their jobs more than lawyers are doctors. At the time, we found it hard to believe—after all, doctors actually help people...

But, we remembered our legal counsel's words while reading Dr. Benjamin Brewer's column in the Wall Street Journal this week. Brewer is a primary care physician, whose work has drawn our attention in the past. We don't always agree with Brewer's positions on policy, but we certainly appreciate his perspective as a primary care physician working directly with patients.

His latest post reveals a frustration familiar to many doctors "waging health battles by fax;" trying to get patients approved for a treatment while fixing a three-year-old girl's finger instead of fixing their lunch. Brewer writes:

I think the hassle factor has doubled in my practice since 2001. Most patients are minimally aware of the battles we fight daily on their behalf. They wonder why the office gets bogged down or why doctors or office staff don't call back. Sometimes I make it through all the hoops to get patients what they need. Sometimes I don't. I failed to convince a patient's insurance company to approve a stronger, brand-name cholesterol medication, because her triglycerides had remained uncontrolled on a generic medication for only five months, not six. Next month I'll probably be able to get her what she needed in the first place, but my staff and I will be forced to do all the same paperwork again.

As we noted last Friday, our own doctor recently decided to stop practicing in D.C. and only sees patients in his Virginia office—news we found out only after waiting for an 8:00 appointment that never came. While we were frustrated at the time, we were sympathetic to his plight. It's not easy being a doctor in today's health care system. Nor is it easy being a patient, or for that matter a policymaker. Proposals for medical homes and other payment reforms can help, but ultimately the problems that vex Brewer are a product of our fragmented and dysfunctional health care system. Real relief will only come with comprehensive reform. Until then, too many doctors will be cursing fax machines flashing "PC Load Letter."