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The Assumption

Posted By Lisa Tyndall, Tuesday, November 26, 2013

One beautiful sunny afternoon, my son and I walked in for an appointment with a specialist. This was an appointment that I delayed for quite some time because I was not sure if we really "needed” it, but I finally determined that coming in to talk to the doctor face-to-face was better than continuing to guess and educate myself via the internet. 

When we arrived at this particular appointment, we were greeted and asked to pay the co-pay, which was expected. What was unexpected was the patient coordinator then asking again for my card to pay for the $250 "testing” that was to be done. I said, "But this is our first appointment. I don’t even know if we want the testing. I don’t even know what the testing involves.” She responded, "Well, that is what we normally do for first appointments.” What I wanted to say was, "Not at this first appointment!” Instead I asked, "Well, is it ok for our appointment to just talk to the doctor first to determine our best treatment route? Do we have that option? I just did not plan on spending that kind of money today.” Luckily, she was kind and generous in her response, allowing me the grace to back out of the procedure. Unfortunately, it was too late for her gracious demeanor to completely smooth things over and stop my Medical Family Therapy wheels from turning, because I was already fuming at how this whole process could have occurred for another family, one who was not so bold as to say "Thanks but no thanks.”

Right there in the waiting room it happened, I immediately began ruminating about the importance of patient agency. My son could even tell something was going on, "What’s wrong Mom?” he asked. The injustice of it all, or at least how it seemed, is what disturbed me the most. So many patients may not know that they can speak up for themselves about their own treatment and that they can opt out of an elective expensive procedure. It seemed unethical to me to just assume that a patient wanted and could afford such testing without even an initial consult. 

Now with many more healthcare plans encouraging consumers to pay out of pocket with higher deductibles, instead of the co-pay system, more and more consumers are apt to begin analyzing what is really necessary in terms of medical procedures and appointments. Sounds familiar…the financial world affecting the clinical and operational world, but yet they are still not working together. For those who do not know or who are not so bold as to speak up for what they need, how many will be paying out of pocket for something without informed consent? 

I would imagine that the more empowered and competent consumers feel about their healthcare, the more likely they are to take a more active role in managing their health preventatively. As a consumer, when you respect me and my choices, both inside and outside of your exam room, it translates to reminding me that many of my health behaviors are also choices that either improve or deteriorate my health. Patient agency is one of the founding principles of Medical Family Therapy and it should be a rallying call for all of healthcare. I would argue that we should be encouraging consumers to take an active role in their healthcare. Healthcare providers can help by respecting the rights of consumers to make choices about treatment. Healthcare should be something done with consumers, not something done to consumers. If the healthcare system wants people to be invested in taking care of their health, then it needs to invest in them and the effects of their financial and operational policies.
Patient agency is one of the founding principles of Medical Family Therapy 

We did meet with the doctor that day, and I explained that we just wanted to talk before moving forward on any procedures. He was kind and understanding of my hesitation to move forward with the testing, and largely because of his kindness we will return to his office should we choose to take that route. After it was all said and done, I was reminded of the importance of making my voice heard when it comes to my healthcare choices. We can no longer afford (often literally) to be intimidated by medical lingo, white coats, and sterile surroundings. I am lucky, however, and am grateful for the skills I have learned as a Medical Family Therapist because it is those skills that I can use not only professionally, but also to exercise my voice in all future personal medical appointments. But we must remember that many others have not been privy to this kind of training and may not know how to exercise their rights as a patient. As Medical Family Therapists and as collaborative care professionals we can play an important role in making sure patient’s voices and wallets are respected and heard and these days that is more important than ever.

Lisa Tyndall is the Clinic Director for the East Carolina University (ECU) Family Therapy Clinic in Greenville, NC. She has her license in Marriage and Family Therapy, and received her doctorate in Medical Family Therapy where her dissertation research focused on developing a consensus definition of Medical Family Therapy. She is the beaming mother of two fantastic young boys and adoring wife to her husband, Richard.

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