There are lots of generalized complaints out there about insurance companies increasing physician workloads without additional compensation. I thought I would share a specific instance of this so everyone else can get an idea of what we’re up against.

I received the following mailing:

We want you to screen our members for cancer.  Please do these things:

• Call the member to discuss colorectal, skin, and prostate cancer screening.
• Refer the member for colonoscopy, or schedule an appointment for skin and prostate cancer screening.
• Flag each member’s chart to remind you to discuss cancer screening at his or her next office visit.
• Enclosed please find several hundred dollars extra in payment for your time.

Obviously I made up that last point.

Following this was a two-page, single-spaced list of patients, some of whom have never been to see me, yet are considered “members” because they were randomly assigned to my office when their employer randomly assigned them to the new plan because they could never be bothered to plow through all that messy paperwork.

Know what I did with that mailing? I pitched it.

FIrst of all, I always discuss appropriate cancer screening with all patients at every visit. Blood pressure check on new med? Sure. When was your last mammogram? Summer cold? Fluids, rest, and analgesics, and you don’t need a colonoscopy because you’re 45 and your family history of colorectal cancer was a grandfather diagnosed in his 70s (doesn’t change the default recommendation to start screening at age 50.) Yes, that rash looks like Lyme disease, and while you’re here, we really should schedule you to come back for a pap since it’s been six years since the last one.

Next, what does “flag the chart” mean in the age of electrons? And why do I need a special note telling me to do something I always do every time anyway? Talk about alarm fatigue.

My job is to take care of patients. (Not populations, but that’s a different post.) One at a time, as they come into my office. No, the office visit isn’t the only way I provide care anymore, but establishing a doctor-patient relationship still requires a face-to-face encounter. After that, it’s damn the appointments, full electrons ahead (phone, text, email, Facebook message, etc.).

Outside of that, if they want me to provide professional services (like calling patients, discussing screening tests, making referrals) they need to pay me. Can’t be bothered? Then I’ll pitch their mailing. Every time.

Lucy Hornstein is a family physician who blogs at Musings of a Dinosaur, and is the author of Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor.