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The article in the July 18 issue with the headline "We’re Not Winning Managed Care Battle" quoting Alan Stone, M.D., seems so fatalistic. Fighting with gatekeepers, review nurses, adjusters, and review physicians is frustrating and exhausting, but it’s meant to be—to discourage us practitioners from even asking.
Well, I’m not quite ready to throw in the towel and leave my fate and that of my patients to miserly managed care. When a reviewing psychiatrist tries to chisel me down, I ask him about his training, where he’s licensed, and experience. I tell him I have done utilization review for my municipality and that he’s a sellout and a whore. I tell him that I will not accept his advice and limitations, as I know more about the patient than he. I also tell him that he’s incompetent and reckless to suggest such reduction in treatment.
I go on further to tell him I will not be able to care for the patient safely with such limitations, so the insurance carrier will have to find another psychiatrist to care for its insured. I add that I intend to inform the referring physician, the patient, and the family that, should the patient kill himself or someone else, they need to place the blame on the reviewing physician personally, his review company, and the insurance carrier.
The responses that I have had to date have been most gratifying!
William B. Donovan, M.D.
San Antonio, Tex.