Table 4.

Selected comments from data cards (physician indicated that hassle interfered with quality of care and/or the patient-physician relationship)
Had to leave the room, get physical therapy referral list, found out the location nearest her house is not covered by insurance; will have to call to see if they will see her Patient had mammogram without authorization; time spent straightening it out Trying to refer patient to pool therapy program at hospital X; had to get clarification if health plan will cover the service Patient with 20-year history of bipolar disorder, no psychotropic drugs covered by plan Long-term patient, new to managed-care plan; medication that patient currently is taking is not effective in managing lipids, and medication that worked previously is not on formulary I get angry; patient gets anxious Patient upset because she may not be able to continue to see me under new HMO plan Referral was lost in paperwork; delay in repeating study for esophageal varices Patient wanted consultation with out-of-plan specialist at academic center X; had to tell patient that the consultation was not covered Needs home care visit; HMO didn't know who was contracting with them to provide home care this year; had to call around and inquire—delay in getting patient seen Patient changed plan; required new prescriptions written for all medications and also change in others due to new formulary; new drugs may not work as well as old drugs Patient with presumed ulcer disease—formulary restricts choice of medication; patient perception of “limited treatment” erodes doctor-patient relationship
HMO=health maintenance organization