Healthcare physician to patients: read before you make a fuss

Contents

The addressee of patients’ complaints should not be a doctor
Drug reimbursement
Primary Healthcare Tests are not available
Unnecessary services in POZ

«Patient, before you make an argument in GPC, consider whether the addressee of your complaints is actually the clinic staff. I know you pay premiums and I would like you to get advice, research and medication cheap, on time and well. It does not always depend on me, however, »writes Maciej Pawłowski, a POZ doctor from Łódź, in a letter to MedTvoiLokony.

“There have been many articles negatively evaluating the work of POZ, so I would like to present the doctor’s point of view and the problems I usually struggle with,” writes Dr. Pawłowski
One of the sensitive topics is the issue of drug reimbursement. “My great disgust is the fact that doctors let themselves be reduced to the role of servants of a certain group of officials who determine the issue of reimbursement – writes the author of the letter, giving many examples of controversial reimbursement rules.
Another contentious issue is the issuance of test referrals. «I often encounter a situation where a patient comes to me who asks me to order a given test, and it is not possible because it is not included in the guaranteed benefits basket, writes Pawłowski
You can find more such stories on the TvoiLokony home page

I am a GP, I work in Łódź. Due to the fact that many articles negatively assessing the work of PHC have appeared, I would like to present the doctor’s point of view and present the problems that I usually struggle with. The goal is to improve communication between the patient and GP, as well as to discuss issues that are rarely discussed in the media.

The purpose of these publications (which are not sponsored) is not to try to “whiten” at any cost POZ, because there are simply people who sometimes act disproportionately to the situation, make mistakes, etc. However, there are more and more accusations, and they are largely the result of a misunderstanding of the specificity of work in POZ, but also of general regulations. This ignorance is shown mainly by patients, but also by some of the medical personnel who have never worked in POZ.

The addressee of patients’ complaints should not be a doctor

I am not an enemy of patients. My understanding is inspired by the argument of patients that they pay premiums and cannot obtain consultations or tests. I would not be happy with this fact myself – especially if I was earning a lot of money and thus paying large health contributions, not being able to get an appointment or referral for research, or paying a lot for drugs. The problem is that the addressee of these complaints should not be a primary care physician, and unfortunately this often happens because patients do not know how the system works.

Here are some common misunderstandings:

Drug reimbursement

I am very disgusted with the fact that doctors have let themselves be reduced to the role of servants of a certain group of officials who determine the issues of reimbursement. This doctor should not be of interest, the doctor should prescribe the drug in accordance with medical indications and own knowledge, a drug that will help the majority of patients. He should write out the drug and ask another person. Unfortunately, you still have to waste time and check the refund for a given preparation, which may change every few months and therefore the visit is longer. Patients and even some doctors confuse the reimbursement criteria with medical indications. The fact that a given drug helps for several disease entities does not mean that it has a reimbursement for all of them. Weird? Sure it is strange, but it is not the fault of the primary health care physician.

Examples:

preparat Xarelto 15 i 20 mg (rywaroxaban) – medical indications: Prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation with one or more of the following risk factors: congestive heart failure, arterial hypertension, age ≥75. age, history of diabetes mellitus, stroke or transient ischemic attack; Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) and prevention of recurrent DVT and PE in adults; Treatment of venous thromboembolism (VTE) and prevention of recurrent VTE in children and adolescents <18 years of age and weighing ≥30 kg after at least 5 days of initial parenteral anticoagulation treatment - these are the main medical indications,

– while the reimbursement criteria (which include only 14 tablet preparations and not 28 tablets (sic!) are as follows: Treatment of deep vein thrombosis in adults 18 years of age and older; Prevention of recurrence of deep vein thrombosis or pulmonary embolism – after acute deep vein thrombosis in people over 18 years of age; Treatment of pulmonary embolism and prevention of recurrent deep vein thrombosis and pulmonary embolism in adults – that is, atrial fibrillation no longer! Then you should prescribe a full-paid drug, which is not cheap.

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Another even greater absurdity – flu vaccines: for example, Influvac tetra – only 50% reimbursement in selected people (with some comorbidities) only between 18 and 65 years of age. So a patient with asthma aged 66 will pay 100%, and a 40-year-old will pay half as much (the refund is 50%). People blame it, because why should a 70-year-old pensioner pay more than a 40-year-old for a good job? I understand it, but this is obvious clerical stupidity, but who is blamed for it? A health care physician, not a clerk. Why, I don’t understand that. It is not me who is making up a refund, and I have to explain myself to the patients of the administrative stupidity, a topic that should not interest me. Needless to say, such an argument means that I could see one more patient, and I will not.

There are many more such reimbursement absurdities, it is impossible to discuss them all in this article. And the National Health Fund is rubbing its hands, conducting an inspection and punishing the doctor for an undue reimbursement up to several years back, even at the price that the patient, due to the price of the drug, will not buy it at all and its condition will worsen (not every drug has a substitute or a preparation with a similar spectrum). actions).

Primary Healthcare Tests are not available

I often encounter a situation when a patient comes to me who asks me to order a given test, and it is not possible because it is not included in the guaranteed benefits basket.

This list does not cover all tests, it does not state that a doctor may order any tests depending on the patient’s health condition. Patients do not know this list and many doctors who do not work in the primary health care center do not know it either. And this is the cause of misunderstandings – for example, a patient requires computed tomography, I agree that such a test is needed, and I cannot order it. Not because I don’t want to, but because it is not in the basket.

Not everyone can afford to do privately, the queues to outpatient specialist care, where theoretically one can get such a referral, are long, and the patient’s condition is not serious yet, he does not qualify for urgent admission to he doesn’t want to, and he says it right away). In a year’s time it will turn out in the tomography that the result is wrong and performing the tomography earlier could make the treatment implemented earlier would be more effective. I agree with all of this, but I disagree with the fact that I am guilty of it. The patient required a tomography, I said that, I referred for “urgent” to a specialist clinic, and “urgent” is a year of waiting, and the planned one is two years, and the patient cannot afford a private examination. Is the primary health care physician really to blame for the whole situation? The patient actually pays premiums, and he has to wait many months for the examination, I understand the nervousness, but I am not the addressee. Another issue (but it will be in a separate article) is the financing of POZ based on the capitalization rate.

In short, I would like to say that a patient may not even receive a list of tests from the health care center, because if the clinic receives 18 zlotys for him for a month, and the complete set of tests from the list costs 300 zlotys, that’s what it is. But it is not the primary health care physician who determines how much the payer transfers to the patient per month. The average GP (and I consider myself to be such) will not be disturbed personally if the patient (especially with risk factors) does a panel of basic examinations and the doctor comments on them. The lack of funding for this research will be a problem, but that’s how I wrote the topic for a separate article.

«There is panic on discharge from the hospital. They don’t want to go back to the border »

Unnecessary services in POZ

Articles on how a patient was unnecessarily referred from primary health care to a hospital or clinic, or how a patient had not been tested, were written many times. I agree that such situations can happen, but the stick has two ends. How many times did I have to write out a sick leave for a patient who had a fracture at the HED, and he did not get sick leave or referral to a specialist clinic? How many times did the patient come to see me because a cardiologist, neurologist or other doctor recommended him to undergo certain laboratory tests (which should be ordered in this specialist clinic, not in a health care center)? If the cardiologist sees the need for a neurological consultation (it is possible that she is, I do not dispute it), then he should write a referral (for a visit to the National Health Fund), and not send him / her to the primary health care facility. How many times would nurseries, kindergartens send a healthy child to certify that he is healthy and can go to kindergarten? How many times did the employer come up with nonsense certificates for employees, which they were supposed to get in the POZ, and they are not listed or are not in the benefits basket – for example, a certificate of breastfeeding, release for isolation covid or quarantine or a certificate of admission to perform a certain job?

Apart from the fact that the patient should be released at the admission room and not block visits to the primary care hospital in this way, such a patient (healthy in terms of infection) will sit for half an hour in the waiting room next to the coughing person (who, for example, additionally “forgot” it earlier) report) and leaves the clinic with the flu and comes back to this primary health care center with a break, but with flu symptoms. Does it make sense? There isn’t. Is this what a primary care physician is to blame? No, it’s not. The fact that someone referred a patient to a primary health care center does not mean that someone was right and that health care is the right place to get some benefits.

Two illegally sent patients for sick leave or for referral to primary health care are equal to two fewer admitted patients who really need it, and this health care center is actually the place where these services are provided. I tell my patients (usually by writing such a referral or dismissal) that they probably fell victim to “bulldozer therapy” and in the future, when they call feverishly, they may not be admitted, because I am writing someone a sick leave which was refused in the emergency room or I am writing a refusal for a beautician because she requested a panel of tests for the patient, which is not included in the basket of health care services and there are no medical indications for commissioning these tests. Most patients understand this, it sounds better than “I won’t take it because I won’t!” and it is true, because I want to see patients (I prefer those with a fever than those with a list of tests from a beautician), they are not my enemies for the most part. But, unfortunately, not all of them, some of them argue and say that the patient must have at least teleportation no later than 24 hours after reporting, which is also sometimes applauded by the army of officials from the National Health Fund or the Patient Ombudsman, even if it is such an important topic as research for a beautician, because the legislator does not details the scope of advice in the regulations. Well, as Minister Adam Niedzielski said, “And the maxim will be: I pay and I require”.

Mr. Minister, with all due respect, I agree that the patient should receive benefits quickly and accurately, but don’t you think that by paying a dozen zlotys a month for a patient in a health care center (which is less than a two-course dinner in a milk bar), these requirements do not but should they be excessive? Is it reasonable to pay less than in a C-class milk bar and expect benefits like in the Hilton? Let us answer ourselves. I emphasize that I have nothing to do with Hilton and I have nothing to do with the patient being diagnosed quickly and efficiently (I would even wish that).

To be continued…..

Patient, before you make an argument in GPC, consider whether the addressee of your complaints is actually the clinic staff. I know that you pay premiums and I would like you to get advice, research and medication cheap, on time and well. However, it is not always up to me.

Maciej Pawłowski, MD, PhD, primary care physician from Łódź

Healthcare physician to patients: read before you make a fuss

The addressee of patients’ complaints should not be a doctor

Drug reimbursement

Primary Healthcare Tests are not available

Unnecessary services in POZ

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