Farewell to the family physician Health care upheaval severs relationships dear to many patients

October 23, 1995|By Diana K. Sugg | Diana K. Sugg,SUN STAFF

As the U.S. health care system is being remade from top to bottom, the upheaval has shaken the most basic and personal of all the pieces -- the relationship between patients and their doctors.

Helen and Joseph Marchand just lost the physician who detected a life-threatening build-up of plaque in Mr. Marchand's arteries. Charles Hall will lose the doctor who he feels has come to know him as no one else could.

Celeste Dunstan said goodbye twice to the family physician she could call at 10 p.m. if she had a problem with one of her children. He's the doctor who diagnosed her colitis when several others were stumped.

Now she swears she'll pay out of pocket rather than lose Dr. Joseph Zebley again.

"He's not only a doctor," said the Baltimore woman. "He's a friend of our family, and we all love him very much."

Dr. Zebley, who still makes house calls to the elderly, has many patients who come and go so quickly that he doesn't get to know them the way he would like. In the past, when he got a call from an emergency room, he could recite a patient's history off the top of his head. Now when he gets those calls, he says, "I don't have a clue as to who they're talking about."

To cut health insurance costs after years of increases, companies have turned to managed care, where all health care is coordinated through primary care physicians, who limit expensive, sometimes unnecessary visits to specialists.

More changes ahead

But that means huge numbers of patients are switching into managed care plans -- often forcibly -- and many must find new physicians. Once in managed care, many must change again because their employer switches health plans to get the cheapest buy.

Doctors are moving too. In order to survive in the new system, they're joining with physician groups, health maintenance organizations and hospitals.

A recent national survey by the Commonwealth Fund found that nearly half of the 3,000 insured adults interviewed had to change health plans. Of those, three-quarters had to change involuntarily, primarily because their employer decided to switch plans.

The survey also found that 41 percent of managed care members who changed plans in the last three years said they had to switch doctors. That compares with 12 percent of those enrolled in fee-for-service plans, in which doctors are paid for each service and patients have little restriction on which doctors they can see.

Still, others say the new system will be better over the long term, because people can pick a primary care doctor whom they know the managed care plan has screened for quality and credentials. Managed care advocates also say their system helps link up many people who never had family doctors.

"One of the advantages of an integrated system is getting people connected with a family physician and setting up appointments when the person is well, so you can establish a rapport," said Geni Dunnells, former director of the Maryland Association of HMOs.

But others contend the opposite is happening.

Celeste Dunstan started out with Dr. Joseph Zebley 13 years ago when her husband, Bert, had to practically carry her into his office. Several other physicians had failed to diagnose her illness even though she had lost 15 pounds and couldn't keep down food or even water.

"As soon as I was there, all of a sudden, I felt like OK, I'm at the right place," said Mrs. Dunstan. Dr. Zebley was soothing and determined. He told her: "We're going to take care of you. We're going to find out what it is." He diagnosed colitis.

Since then, the family has experienced what's called "rebounding," where patients move in and out of doctor practices every few years as their companies switch health plans. The Dunstans saw Dr. Zebley for years, until her husband's company switched to a different plan, and they had to find another doctor. Two years later, the company switched back, and they rejoined Dr. Zebley's practice. When the company changed plans a third time, they found yet another doctor.

After the company's latest switch, Mrs. Dunstan and her husband pulled out the plan's list of doctors and rejoiced: Dr. Zebley's name was there.

Critical issue

Some feel it's a life-and-death situation.

Four years ago, when Joseph Marchand's employer switched health plans, the Marchands lost their physician of 16 years, Dr. Joseph Deckelbaum, a man Mrs. Marchand considered like family.

Gradually, though, the Baltimore couple found confidence in their new physician, Dr. Leonard Lichtenfeld, an internist who monitored Mrs. Marchand's angina, high cholesterol and diabetes, and helped keep the conditions under control. He also discovered her husband's arterial blockages.

"Dr. Lichtenfeld saved his life," said Mrs. Marchand, 60. "When I was younger, I never cared which doctor I went to. But today, I want confidence in who I'm using."

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