Dr. Gene Dorio | Medical Decision-Making

Letters to the Editor
Letters to the Editor

The practice of medicine has been augmented by advancing technology. But even with four years of medical school and an MD degree, this only provides the foundation of what is needed to be a good doctor. A critically important ability is learning to make good medical decisions.

This is why there is hierarchy in training, starting after medical school in internship, residency, fellowship, and then becoming a staff physician. At each level, one learns, implements and then teaches the necessary thinking process to improve one’s ability to become proficient in effective medical decision-making.

Today, one of the biggest challenges doctors face is the intervention of those who wish to usurp medical decision-making away from experienced and evidence-based physicians. 

Those intervening include insurance companies, hospital administrators, medical groups including HMOs, and pharmaceutical companies. These entities put profit in front of patient care, and even contradict the Hippocratic oath physicians have taken.

We’ve all likely experienced denial or minimized insurance coverage when we have a car accident, or fire has burned our home. 

Within the realm of medicine, I have witnessed stacks of “prior authorization” requests illegally tossed into trash bins by profiteering HMO personnel jeopardizing the health care of their patients.

Nowadays, if you need a special radiology test like a CT scan, MRI, or PET scan, it might be denied by your insurance company. Getting a referral to a specialist can be difficult, and even having a timely surgical procedure that might be needed to evaluate cancer could end up in the trash bin.

Typically, insurance company physicians or their other health care providers are making these decisions yet have no background in an area that might require educated expertise.

Continually, doctors complain of “peer-to-peer” prior authorization discussions with insurance gatekeepers who have no concept of the medical knowledge to appropriately evaluate the situation, and utilize an algorithm to justify blocking the medical need for your doctor’s request. Most of the time, their credentials and background are unknown, and we don’t even know if they have taken the Hippocratic oath. 

Often, time is of the essence for a physician to make a diagnosis, but notably the extra paperwork leads to roadblocks of your doctor’s efforts. 

Sadly, this is the health care system American citizens now face, as clearly it is based on profit.

I believe around the world there are many countries that provide worthy health care to their citizens. Available U.S. data now reveals life expectancy and maternity health care reflect a failing health care system.

One of the cogs in the wheel at this point is medical decision-making, which must be put back into the hands of well-educated and honed health care physicians to provide worthy care.

If not, our system will continue to settle in the health care trash bin.

Dr. Gene Dorio


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