Docsplainin' -- it's what I do

Docsplainin'--it's what I do.
After all, I'm a doc, aren't I?

Monday, May 24, 2010

Blue Cross Blue Shield Of Georgia Is Skimping On Mental Health Care, Says Georgia Psychological Association

This story is from last year. I found it when I Googled Blue Cross/Blue Shield tonight looking to download an Outpatient Treatment Report form for a patient. Given the problems I've had recently had getting treatment re-authorized, I also downloaded a 50-page explanation of what Blue Cross/Blue Shield considers "medically necessary". You can read that for yourself here. I found it enlightening.

Because I am on their panel and neither wish to be tossed off it nor to have clients convicted by association, I'm not going to say anything more.

You can read the article for yourself as well:

Blue Cross Blue Shield Of Georgia Is Skimping On Mental Health Care, Says Georgia Psychological Association

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Wednesday, May 19, 2010

Why I Hate Managed Care in General, and the Medical Model in Particular

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So this arrogant psychiatrist in another state, who has never met nor spoken to my patient, decides in less than 10 minutes on the phone* to deny coverage for depression and ADD because she's made only minor progress in 12 weeks of outpatient psychotherapy ("three months!" quoth he, obviously horrified).

Oh, yeah, and because she's not getting "standard" (read: "cheaper") treatment, to wit, psychotropics.

He actually asked me why I was asking for more sessions! Um, because she's still depressed? still has family issues? Still doesn't know what she wants to do with her life? After all, he says, it's not working, is it?

Yes, it is. It may be slow, but it is working. Her problems have been years in the making and we're not going to turn them around in three months. He seemed astounded by this concept.

He implied more than once that my treatment of her was substandard. She wants a non-drug solution and I'm not forcing the issue, partly because her depression is moderate, therefore not an emergency, and partly because most of it is environmental in origin, not endogenous. As for the ADD, well, it is definitely holding her back, but it's not going to kill her, and I see the decision whether to medicate or try adaptations and accommodations as a personal one. I respect patients' ability to make decisions like that for themselves, and support their right to do so.

And by the way, the standards of care are written by--wait for it--the American Psychiatric Association.

Not to mention, success with medication is hardly guaranteed. I have had dozens of patients who have not responded to medication after medication after medication. Do insurance companies then want to stop paying for any more drugs? No. This is about money, pure and simple, and it pisses me off. This, people, is why we need national health care.

So if your insurance company doesn't want to pay for ongoing psychotherapy, fine. If it doesn't fit within their definition of "medically necessary," fine. I get that, and I have no problem with it. But don't imply that my work is substandard, dude. Do not go there.

*actually, he'd clearly already made up his mind before he even picked up the phone, based on a one-page request form I'd faxed in. I suppose I should have claimed "moderate" progress on the form. Her role functioning has improved because she's learning to structure herself better ("yes, but is her concentration better?" the insurance company care manager wanted to know) and she's made one of the major life decisions she came here to make. But I really feel we're just getting started. "Moderate" to me implies that we're about halfway through. "Major" progress would be close to the end, right?

While I was writing this the care manager called to see if I wanted to appeal. You betcha! And she pointed out that this all happened because I didn't return their calls quickly enough to suit them. I got passed on for this "peer review" thingy (Do you really think he's my peer? Do you think he's got a doctoral degree in psychology and 30 years experience providing psychotherapy?) partly to punish me.

Anyways, if I had, she went on to say, she "might" have given me two more sessions!! to get the client to agree to a med consult.

Makes me want to set my head on fire. 
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Monday, May 10, 2010

Mental Housecleaning Time

"What's on Your Mind?" is the prompt for Facebook status updates.

Recently, I've noticed that there's a lot of junk on my mind, much of it unpleasant and worrisome. We unconsciously shovel in junk all day with the news, tv shows, and even the books we read! So after serious consideration (and one of those "last straw" experiences) I'm giving up reading fiction with any form of violence in it.

Which means most of my beloved murder mysteries and thrillers. I used to love, for example, the Dick Francis mysteries because they were all about horse racing. And you know how I feel about horses. But the novel I've just finished involves bad guys abusing horses, and one disturbing mental image in particular stuck with me long after the book was done. And I thought, why would I traumatize myself like that on purpose? Don't we have enough in our real lives to worry about as it is?

Jon Kabat-Zinn suggests that we think of what information we take in the same way we think about our diets: Pay attention to what floats up unbidden in your mind from things you've read, heard on the radio, or seen on tv. Be mindful of what you shovel in during the course of a day. See what you might want to change.
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