Doctor 's efforts to improve the medical care they provide to patients often get lost in reports of drug recalls and claims of increasing medical errors. On Call talked to dermatologists around the country about ideas they have for improving the quality of care provided in doctor's offices. For most, improved care results from enhanced adjunct services, such as the way the offices deal with insurance, or how their staffs attend to details.
Yuelin Xu, M.D., of Lansing, Mich., says that too often medical care is compromised by insurance company guidelines. He says doctors must become advocates for the patient.
"If you do things based on what the insurance covers, I don't think you're giving the best care. The best care we currently give is realistic, available and affordable care. But true 'best care' is an idea where you don't worry about the cost; you don't worry about the conditions; you don't worry about anything, you just use the best option available, but that is not the real world."
"I keep dictating letters to insurance reviewers, so the patient can get their treatment plans approved.
"The staff calls the insurance companies - sometimes HMOs are good enough that if you fax them something, and fill out a form, they okay treatments that aren't on their reimbursement schedule, such as Retina-A for patients over the age of 25. If we petition the companies, they usually approve it for a year. So we do what we can - but patients have to fight as well."
Stewart W. West, M.D., in Great Falls, Mont., knows that dealing with insurance coverage is a major hindrance in providing the best possible medical care. He tries to individualize his approach to a patient's prescription plan.
"I have my nurses go in and figure out if the patient has an adequate plan, no plan or a bad plan to help steer me in the direction I should take for prescriptions.
"I live in a rather poor part of Montana so if the plan doesn't cover what I want to prescribe, I try the generic first, but if it doesn't work out, I petition the company to approve the non-generic."
Manufacturers' help Dr. West also uses drug manufacturers' programs to benefit his patients.
"A few of these companies have programs if people are low enough income - and about half of the people I work with qualify - you can get medications at extremely low prices - like $12 for the biggest tube of Elidel. So trying to keep patients from going broke on their medications is pretty important."
Another practice of Dr. West's is to call his Mohs' patients the evening of their procedure.
"I call them at 8 o'clock to check on them. It's only a one-minute phone call to each person, so it takes maybe 10 minutes. A doctor at a meeting suggested we do that and I thought it was a great idea."
In practice for three years and a member of a large multi-specialty group, Dr. West says his group has started developing a team approach to patients, but he says it's still suffering growing pains and that makes things a bit tedious right now.
Team approach Janice W. Yusk, M.D., in Louisville, Ky., says a team approach can work when everyone is accustomed to it. The nursing and clerical staffs in her office cooperate in a system of checks and balances.