“What questions can I answer for you about your anesthesia?”
I ask patients this question thousands of times a year, at the end of every history and physical I do prior to bringing them to the operating room. I phrase it this way for a very specific reason (versus asking them, “Do you have any questions about your anesthesia?”) because I want people to know that questions are in fact the expectation, not the exception. And so, in my nearly two decades as a practicing anesthesiologist, I’ve answered a lot of questions.
Credit: Photo contributed by the candidate
Credit: Photo contributed by the candidate
Patients want to know what medications I plan to use and how much I plan to administer. They ask about my equipment, what size of tube I intend to use to intubate their trachea, what I plan to do about their pain, how long they will be in the recovery room before their family can come back to see them. They ask me whether they will need blood transfusions or urinary catheters or about complications they experienced during previous surgeries. They ask me what I will do if their heart stops beating during surgery and whether or when we will start CPR or defibrillate them if that happens.
I love it when patients ask questions. It shows me they are engaged in their care, and for the most part I can answer with some certainty, even if sometimes the answer starts with the lawyerly caveat, “Well, it depends.” Taking care of patients and their families guided by science, clinical best practices and simple human connection is what doctors do best, and answering those questions is part of that care.
But one question I get asked more and more by patients is one I have a difficult time answering confidently. And the question posed, regardless of the urgency of the surgery, and regardless of how vital anesthesia care is a part of it, is: “Will my insurance cover it?”
The recent death of Brian Thompson, chief executive of the nation’s largest health insurer, UnitedHealthcare, has unmasked a dark and savage rage in our country toward the health care system and the multibillion dollar entities we pay to cover that care when we need it most.
It has been reported that the bullet casings used in the fatal shooting were lettered with the words “DELAY” and “DENY,” phraseology commonly used to describe cases in which insurance coverage for medical care is refused. And the public response to this killing has been shocking even for those of us exposed to the grinding frustration of the health insurance landscape daily.
Across the internet we’ve seen exhibitions of unrestrained glee and gallows humor, many implying this type of public execution was justified for the leader of a company many hold responsible for inflicting mass harm and suffering in a country where families are routinely bankrupted by health care expenses. Though photos of the suspected shooter have been made public and the search (as of this writing) is ongoing, some view the suspected murderer as something of a folk hero, cheering his escape and encouraging those who might have further information not to come forward.
This has particular relevance here in metro Atlanta, which the New York Police Department is now investigating as the gunman’s possible point of origin days before the shooting. New York Police announced Monday that a suspect had been arrested after being spotted at a fast-food restaurant in Pennsylvania.
I want to be clear: Celebrating a brazen act of cold-blooded murder is unacceptable. Full stop.
But I think the public response, even in an age where social media has become increasingly vicious, has revealed something deeper about the simmering fury Americans feel in this moment, watching profits being prioritized over people and multibillionaires are leveraging their wealth into political influence at the highest levels. Overlay onto that the environment of health care, one of the most personal aspects of all of our lives, and you might start to see something like the near-mythic ethos being constructed, where an unknown assailant guns down a father of two in the middle of one of the busiest cities in the world, evades capture and is celebrated for it.
As a doctor, I take care of patients the best way I know how, the best way I was taught to do. And in my ideal world, none of the choices I make in the course of that care would be influenced by insurance coverage concerns. We would use the treatments research has demonstrated work best, not just those insurance has demonstrated it will usually pay for. Whether I provide anesthesia would be determined by patient safety, comfort and preference, not be dictated by cost concerns. We would practice medicine based on what the patient needs, not what an insurance company has determined is enough.
After more than two decades of clinical practice, I am not naive to the intractable mess of the current American health care system, nor do I believe there to be an easy or painless fix. But I listen to the questions, and I hear what I am unable to answer.
I carry with me hundreds of stories of patients who have delayed, forgone or refused care because of concerns that the care will bankrupt their families. I have seen my colleagues at the hospital brought to tears of frustration because our insurance landscape precludes the care they took an oath to provide. And I have seen the preventable suffering that results and the rage that cultivates over time.
Will my insurance cover it?
“It should.”
It’s the best answer I can give.
Dr. Michelle Au is a practicing anesthesiologist in metro Atlanta and a member of the Georgia House of Representatives.
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