(Snippets from the frontline)
Trumping algorithms
While away for the weekend, my patient developed dizziness and “couldn’t walk straight.” Because of his symptoms, he sought help and was seen at a university emergency room where he was evaluated by a neurologist. The diagnosis made was vertigo, so he was released.
When I saw him in the office Monday, his symptoms persisted, and my history and physical exam alarmed me ordering a head MRI. I wanted to get it “stat” but it was denied by the insurance company.
Tuesday I spent 21 minutes on the phone in “peer-to-peer” discussion, although it was easy to tell the insurance physician was following a checkbox algorithm to see if the patient received enough “points” for approval. He didn’t. I persisted, and finally got it scheduled.
The next day, he had his MRI revealing structural brain changes and hemorrhage (bleeding) requiring immediate hospitalization.
Despite my 40 years of clinical experience and firsthand seeing and examining the patient, the profiteering business-oriented US healthcare system could have failed him because he didn’t have enough points!
Clinical experience and accumulated expertise should trump any algorithm.
Gene Uzawa Dorio, M.D.
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