Wednesday, August 20, 2014

Story of the day - Is your compassion medically necessary?

John was aware of the power of groups. He had been a counselor for years and had facilitated many groups which were intended to be therapeutic. In the substance abuse field this activity is called "treatment."

The payors, the insurance companies, have required that a medical model be imposed on psychotherapeutic activities like individual counseling, group meetings, family therapy and would only pay for services if these activities met the definition of "medically necessary." The health insurance companies refuse to pay for services which are simply educational, vocational rehabilitation, or case management. The medical records of these activities are constantly scrutinized to determine if acceptable symptoms had been noted, appropriate psychiatric diagnoses assigned, legitimate treatment goals articulated, and progress towards those goals described.

It seemed an arbitrary definition to John whether his compassion, his empathic conversations, his purposeful interaction with clients and their families and referral agents are "medically necessary."

When Jesus raised Lazarus from the dead to ease the grief of his mourning sisters would it have been reimbursed in this day and age by the health insurance companies or when Jesus made a paste from dust and his saliva, and cured the blind man's blindness when he put the muddy paste over this eyes?

As this thought crossed his mind, John started laughing to himself, guffawing really, and his eyes welled up with tears, and his colleague, Shannon, having heard the explosion of frivolity got up and came to his office, looked in, and seeing him alone, asked, "Are you okay?"

John, at first couldn't answer because he was laughing/crying so hard, he couldn't articulate the words properly to speak. Finally, he stood up, took a tissue and wiped his face and blew his nose, and said to her, "I need a day off. I am really not feeling well. I've got to get out of here. Please cancel my appointments or find someone else to cover them. I'll see you tomorrow." and John walked out of the office, down the corridor, out the back door into the parking lot, got in his car, took a big sigh of relief, and drove down to the lake to watch the seagulls and the waves roll up to the beach line.

1 comment:

  1. It gets to the point sometimes where people can care too much. This leads to burn-out. When you not only care too much but you have all these regulators and payors watching every move you make over your shoulder taking care of patients, it just becomes too much some times. I hope that John recharges his batteries and takes care of himself.


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