A quick thought

While completing an outpatient clerkship, I recently had a strange realization about all that was wrong with medicine at my preceptors office. A patient came in with a relatively simple abcess vs. cyst on the medial thigh. It was relatively superficial, not located near anything major, and my preceptor had extensive urgent care experience dealing with things just like this. In fact, I've done the I&D on similar lesions in medical school. So I asked, "are you going to drain that thing?" with of course the glimmer of hope that I might be able to do it.

He said no.

This patient's insurance wouldn't pay him to do it. As he put it, "I don't work for free." He instead spent 20 minutes on the phone referring to a general surgeon, getting approvals, etc... The patient's insurance was willing to pay a PCP bill, send the patient to a surgeon and pay that bill, and then have the patient return to both for more billing. What a bizarre system in which we send the patient to two extra appointments, pay for both, and waste the time of a highly qualified practicioner on the phone all for a simple procedure that the med student could have done and the doctor had done 1000 times before. You wonder why we spend so much money. There must be no real competition in the local insurance industry, because there is no way such a stupid system could survive any real competition.