Outside of our families, is there any relationship as important as the onebetween physicians and their patients?
The physician is the one person withwhom patients share their most intimate concerns, problems and physicalinformation some of which they may not divulge even to their spouses.
Physicians study and train for countless hours over many years to prepare forwhat is often regarded as the most challenging of occupations. Endless hoursand financial resources are invested in specialized staffs, offices andclinics to assist physicians in delivering care, often to patients injured onthe job.
But now, for the fourth year in a row, an organized attack in the FloridaLegislature on physicians practices is under way. The proponents of thisproposed legislation want to intervene in the respected physician-patientrelationship by significantly curtailing, and in many cases eliminating, theability of physicians to dispense medications to injured workers beingtreated under workers compensation insurance. The motivation to do this ispurely financial.
When physicians directly fill prescriptions in the office, injured workersreceive the medicines they need quicker, easier and more reliably, andbilling is automatic. Physicians address questions or concerns aboutpotential drug interactions and provide medication administration instructions at the time of dispensing. The treating physician willultimately treat any side effect. Physicians can talk with patients about howthe medicines being prescribed will be affected by the patients diet andactivities at the time of dispensing.
Further, injured workers often havetransportation issues and are in no shape to travel, much less wait in apharmacy. Retail pharmacies maintain databases with information on apersons health insurance benefits but not their employers workerscompensation coverage, creating more delays.
Many of these workers are from lower income brackets and live paycheck topaycheck. If they think they may have to come up with money to obtainmedicine(s), they may try to wait until payday, making their condition worse.They may even try to go without the medicine, making their condition andpain much worse and more expensive to treat in the long run. How do we put acost on that?
Make no mistake; physicians cannot buy medicines in the bulk amounts thatretail pharmacies purchase. They must recover the costs to provide thisservice to injured workers. Additionally, the meager 1.1 percent estimatedas the projected savings from changes to physician dispensing could be morethan eaten up by worsened medical outcomes for injured workers.
Furthermore,consider that between 2003 and 2010 a period where physician prescriptiondispensing increased significantly pharmacy costs in lost work timeclaims filed in workers' compensation cases dropped by 5.8 percent and the number oflost work time claims decreased by 36 percent. Additionally, Floridas workerscompensation rates are 56 percent lower today than in 2003. Can we point toany other line of insurance where such dramatic improvement has taken place?
Florida lawmakers should reject attempts to interfere in the doctor-patientrelationship and physicians rights to deliver safe, quick relief andrecovery to injured workers.
Rafael Miguel, M.D.,is a Brandon physician who treats injured patients in the workers compensation system.
