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Awareness essential to our staying healthy

It is an election year. Once again, health care comes to the forefront with the public and the candidates speaking out for and against the Affordable Care Act.

It is an election year. Once again, health care comes to the forefront with the public and the candidates speaking out for and against the Affordable Care Act.

But how much do patients really know about how our health-care system works and how current policies affect health care?

Do they realize that having insurance is not the same as having access to care?

Do they realize that insurance guidelines, rather than their physicians' judgment, often dictate whether they can get a certain medicine or procedure, and that the choice of medication may be dictated by what kind of deal their insurer has been able to strike with a particular pharmaceutical company?

Do they understand how new government mandates will affect their care?

Patients do know that their doctor often has his or her face buried in a computer rather than focused on them. Do they know why? They may not realize the complexities of using the new diagnostic coding system, or how much data must be entered just to satisfy third-party payers. It can seem as if the documentation has become more important than the patient!

I now joke with my patients that I am no longer an M.D. My degree is now a D.E.O. - data entry operator.

Documentation is important, but not for documentation's sake - and certainly not when the process appears to become more important than the outcome.

If my patient has improved on a medicine that is being used off-label, continuation of that medicine may well be denied by an insurance company, because it is not "approved" for that condition.

Never mind that the medicine is helping my patient and is well-tolerated. That does not seem to matter.

In the future, physicians will be graded and ultimately reimbursed based on their ability to document that they have met certain predetermined metrics that are deemed to comprise good medical care.

The problem is that these metrics may not be applicable to an individual patient, but they will influence the care that individual patients receive. Do patients really want their care determined by a third party who is not even in the exam room, based on a predetermined, one-size-fits-all strategy?

That, in a nutshell, is what is happening. Physicians are losing the ability to make decisions regarding how to take care of our patients.

We are frustrated and upset about policies that we feel detract from our ability to help individual patients.

That's why it is important that we make the public aware of these policies and how the patient-physician relationship is being harmed.

To this end, the medical societies of Philadelphia, Montgomery, and Bucks Counties will be holding two health-care town hall meetings:

Oct. 6 at 6 p.m. at the Wellness Center, 847 Easton Rd., Warrington;

Oct. 19 at 7 p.m. at the Philadelphia County Medical Society, 2100 Spring Garden St., Philadelphia.

The goal of these sessions is to start a dialogue between patients and physicians as to how health care for patients is being affected by current and changing policies from third parties. We will also be inviting legislators and insurers as we strive toward greater understanding.

We hope to see as many of you as possible on Oct. 6 and Oct. 19th.

Mark Lopatin is a rheumatologist in Willow Grove, and chairman of the Montgomery County Medical Society.