Inside this issue

Updated Masthead YPF 2017

Inside this issue: October 2017

by Elisa S. Gallo, MD, physician reviewer, DW Young Physician Focus

Elisa S. Gallo 4When I was little girl, I was privileged to learn about what it means to be a doctor from one of the smartest and most compassionate physicians I’ve ever known. My uncle, who practiced medicine in the heyday of the fee-for-service reimbursement era, would take me with him on his rounds and then to his clinic. After work, we’d go back to his house and inevitably find something waiting on his front doorstep. From beautifully knitted blankets and hand-painted masterpieces, to bushels of corn, fresh-picked strawberries, homemade casseroles, and scrumptious cakes and pies, his reimbursement from those who couldn’t afford his services left me standing in awe of how he operated. In my child’s mind, being a doctor meant that you’d keep warm, look at pretty pictures (and perhaps a few a bit bizarre), and eat well. It took over another decade for me to realize compensation had become a little more complicated than that.

In training, the last thing on my mind was what I considered to be the dark side of medicine: the burdens of business. Admittedly, unless there was a reason I had to take note, I rarely identified self-pay versus insured patients. Rumblings of insurance regulations — leaving doctors to wonder who was truly responsible for their patients’ care — had just reached the horizon, as it was nearly impossible to start a particular medicine without first proving a patient had failed other treatment modalities. Money, though, was not my concern; patient care was paramount to finances.

In this month’s issue of Dermatology World, the feature article “Balance Due” addresses the changing landscape of getting paid for services rendered. As a young physician — some days hanging onto my idealism for dear life — I find myself regularly dealing with all but what I learned about the practice of medicine. Instead of being concerned primarily with patient care, I’m frequently forced to fight, and sadly must occasionally capitulate, to insurance regulations set forth by those who don’t have the heart to stare into the eyes of another and discuss less than ideal treatments, when we all know better alternatives are available.

I still believe my primary purpose in life is to help humanity — though all too often my focus must shift from the practice of medicine to the practicalities of medicine. As this month’s article addresses the problem, editor Abby Van Voorhees, MD, suggests that equipping ourselves with an understanding of our patients’ perspective is critical to dealing with costs our patients can’t afford. Simply writing a prescription is not helpful if a patient can’t pay to fill it. High deductibles dissuading patients from pursuing follow-up care can have dangerous consequences, especially in those with a history of skin cancer. Understanding current health insurance issues our patients face is essential to helping them navigate a system that clearly does not have their best interests — nor pocketbooks — at heart. While this isn’t what many of us signed up for when we chose to devote our lives to medicine, it’s still a means to help people in a way that has no monetary value. As I sit with a warm blanket knitted by a grateful patient around my shoulders, I have no doubt that I’m doing the best I can to conquer the divide.