(Snippets from the frontline)
Gatekeepers
My senior neighbor, an avid walker, developed a knee problem with pain, swelling, locking, and popping. She went to an HMO primary care doctor who ordered an x-ray and physical therapy. Symptoms persisted.
After two months, she saw another doctor in the same group requesting an MRI, which was denied.
Three months later with continuing symptoms, she asked for an orthopedist referral (seeing a “specialist” Physician Assistant) who didn’t exam the knee, and sent her back to Physical Therapy.
Her symptoms are classic for cartilage damage, where a good physical exam and MRI could have substantiated the diagnosis.
Instead, “gatekeepers” kept her from the diagnosis markedly limiting her daily activity.
Gatekeepers are on the frontline of medicine and regulate your care. They are typically primary care doctors, physician assistants, or nurse practitioners.
When they are contracted with hospitals or certain insurance groups (like HMOs), there is monetary self-interest motivating decision-making to increase profits. Sometimes these medical professional are even awarded a “bonus” when they minimize medical care.
Patients like my neighbor continue to suffer as I see her limping around home while gatekeepers deliberately thwart her efforts to maintain quality of life.
Gene Uzawa Dorio, M.D.
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