Formulate one new comment of your own. It must be a logical and thoughtful response that synthesizes the comments of at least 3 classmates into one comment. Be sure to synthesize; do not simply reply to each of the 3 classmates.
1. Gatekeepers are primary care physicians. They serve as the first contact in healthcare, so they can control utilization. (Module- 2 Home Managed Care, 2019). If patients were able to self-refer for expensive exams, it would be chaotic. Not to mention the expense for both the patient and insurance companies. There are steps when ordering diagnostic testing for patients. For example, breast imaging starts with an X-Ray (mammogram). If the radiologist sees something that requires further testing, he/she will order an ultrasound, and then a biopsy. If a patient went straight for the biopsy they don’t need, they’d be putting themselves through unnecessary trauma and costs. Some insurance companies will not cover expensive imaging without documentation that the proper steps were taken. Medicaid won’t cover a PET/CT scan if there is not a cancer diagnosis. I worked at a PET/CT imaging center. We had to have documentation and prior imaging results before submitting the patient’s packet for Medicaid approval. It’s an expensive exam and insurance companies do not want to pay for something they don’t have to. We had patients pay out of pocket because they thought for sure something was wrong with them that their doctor could not find. Even then, they still need a doctor’s order before they can get a nuclear med imaging test.
2. The gatekeeper approach is exactly what patients need. Reminder, that the patients must come first, and must be respected within the healthcare process. The most important thing to keep in mind as healthcare professionals, is that if they’re going to take care of the patients, they must abide with the core ethical principles such as beneficence, nonmaleficence, autonomy, and justice (Flite, Harman, 2013). One that pops the most is beneficence, which is defined as “providing benefits and balancing benefits and risks/harm” (Chiropr, 2011). The care should start with the general practitioner or primary care providers, where their roles are to “collaborate with other healthcare providers, such as other specialists and therapists, to ensure the patient has all of their needs met” (Fritzel, 2019). In addition, they must educate patients and have an oversight of their entire healthcare needs. This not only provides the needs of the patients, but benefits them by avoiding unnecessary cost and harm to the patients who decide to take matters into their own hands.
3. As a Primary Care Provider (PCP) they have been given the title of gatekeeper. This means they delegate the path a patient must take to return them to a healthier state if capable. I do believe that the gatekeeper system has achieved its purpose. The gatekeepers can have positive attributes. For example, children have been known to see their pediatrician for 15 years before they age out. So a well established rapport is built and the physician has an understanding of what treatments work whether that be holistic, conventional medicine, or alternative medicine for the patient. Unlike an adult in certain medical systems may see several PCP’s within a timeframe due to the shortage of physicians. Meaning, your PCP has become unavailable for whatever reason, so another physician must cover down on the patient load. Weinstein (2001) commented, “Physicians, each acting in the best interests of their own patients, collectively reach the limits of health care resources, with the result that access to care and quality of care are compromised” (p. 268). Where the negative aspect comes into play as a gatekeeper would be going to the dentist and finding a mass in the annual panorama x-ray. The patient must go though the gatekeeper in order to be seen by an ENT physician which prolongs their treatment. This example seems very minuet, but take for instance a single mom, the finances, time off work, and dragging kids along just to get the gatekeeper to write the consult for ENT. This becomes an extra hurdle just to achieve the end result.
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