Finding Chemo

, , , , | Hopeless | May 27, 2018

(I’m a pre-med student shadowing a doctor to get some experience before I apply to medical school. We’re in the back office, where the doctors all convene at the end of the day to go over their patients and any potential problems or things that need coordinating. The doctor I’m shadowing is [Doctor #1].)

Doctor #1: “Here’s a problem, guys. This patient needs five rounds of chemotherapy, and now, four rounds in, his insurance decides they aren’t covering it, and he definitely can’t afford it on his own.”

Doctor #2: “That’s bulls***. Give me the case file. I’ll drop it with [Office Social Worker], and if she doesn’t have the insurance company begging to pay for it within three days, she’s not the magician I think she is.”

Doctor #3: “What if it takes longer, though? He’s scheduled to get his last round on Friday, four days from now.”

Doctor #1: “If it looks like it’ll take longer, we give him the chemo, anyway. If the insurance comes through, we’ll forward-date it to the time when he’s covered. If [Office Social Worker] just can’t make it happen, though, we give him the chemo, anyway, and request a round from [Free Charity Hospital] to be delivered here, since he’s getting all his stuff done here. It’ll take a few weeks for it to be delivered, but our next inventory isn’t for a month. That’ll give us time to get it into our system so our numbers match. One way or another, this guy is getting his chemo on Friday.”

(Later, as we’re getting ready to leave, I ask:)

Me: “Should I have been in the room for that? It’s not really fraud, but altering the dates on the paperwork is definitely not something they’ll go over in med school.”

Doctor #1: “That’s exactly why I wanted you in the room for that discussion. That’s a thing you need to learn early and well: how to get your patients the care they need, even when the paperwork or the insurance isn’t exactly right. None of what we were discussing was completely kosher, but it wasn’t completely illegal, either, and more importantly, it’s the right thing to do. Your job as a doctor is to take care of your patients, no matter what else gets in the way.”

(It was an important lesson, and one I learned well. I’m starting my residency now, and at least once a week, I find myself wondering, “What would [Doctor #1] do?” It’s yet to steer me wrong!)

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