ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Thursday, January 16, 1997 TAG: 9701160008
SECTION: EXTRA PAGE: 1 EDITION: METRO
COLUMN: BETH MACY
SOURCE: BETH MACY
There was a time, just a few years back, when psychiatrist Enrique Perez got to practice what he calls the ``ideal'' of medicine: working with patients long-term, getting to know them well, helping them.
When he first started his practice seven years ago at Lewis-Gale Clinic, Perez recalls, he'd see no more than two established patients an hour.
And when he quit the job two months ago? His work hours were spent rushing patients in and out of 10- to 15-minute sessions, filling out voluminous insurance forms and arguing with managed-care providers who pressured him to cut corners, cut costs and - he strongly believes - cut the ``care'' out of his practice.
Perez, 36, is a mild-mannered man, prone more to analytical discussions than passionate discourse. He comes from a long line of physicians - his parents are both pathologists in Radford; his brother, Tony, is an anesthesiologist in Roanoke.
Growing up, he always knew he'd become a physician. But not until he attended medical school at the University of Virginia did he become drawn to psychiatry, partly because of this statistic: One-half of the patients who seek treatment from a doctor don't have anything physically wrong with them.
``There really is something else people need and can get through sitting down and spending time with someone who cares,'' he says. ``But more and more that just can't happen.''
Longtime psychiatrist Dr. William Clarkson jokes that people entering psychiatry need to be issued knee pads. When a patient is admitted to a psychiatric facility, ``We have to go back every few days, get on our knees and beg for more days.''
He's one of a few doctors who can speak openly about the dangers of scaled-back insurance coverage. The reason: ``I'm close to retirement.''
``Most of the young doctors are intimidated," says Clarkson, of Lewis-Gale Clinic. "They've signed gag clauses in managed-care contracts: If you say anything bad about managed care, [the fear is] you're dropped from the list.''
Enrique Perez is not intimidated. But he is - or will be, in a few weeks - gone.
He and his wife, Pam, a social worker, are moving to Maine, where he's accepted a job at a Veterans Affairs hospital and where, he hopes, he can get back to the real business of helping people. He believes he'll be less pressured to submit billable hours - and better able to treat patients - in a public hospital setting. Perez quit his private practice at Lewis-Gale Clinic on Nov.1, just as PhyCor Inc. was taking over.
``If I wanted my MBA, I would've gone to business school,'' he says. ``Because that's what medicine has become: The patients are just widgets.''
A year ago, he figured the cost-cutting measures were at their worst. Then, he believes, things got even worse.
He felt pressure to reduce the time he spent with patients, to make quicker diagnoses, to spend more time writing prescriptions than doing the intensive psychotherapy he was trained to do.
``Anymore, patients are not authorized to see you long enough - or only when they're in crisis,'' he says. ``When they're sick, we're expected to do a superficial Band-Aid treatment and kick 'em out the door. Then you see them again four months later - when they're in another crisis.''
The situation leaves the physician with no power, but full liability.
``You get to where a whole lot of the rewards are gone and, if you're not careful, all you're chasing is the money,'' he says. ``And for myself, I didn't want that to happen.''
|n n| Perez and other area experts have a few suggestions for patients who believe their medical coverage is insufficient or unfairly denied:
Employees should know their insurance policies and lobby their employers about the need for equal coverage of mental-health illnesses. One in four women and one in 10 men develop depression during their lifetime, according to the American Psychiatric Association.
``A lot of people figure they'll never need psychiatric care.... This is something you can do before the fact,'' says Diane Kelly, who directs the Mental Health Association of Roanoke Valley. ``Businesses need to realize that depression in the workplace does affect the bottom line.''
Of course, people who suffer from mental illness may be afraid that employers will hold it against them. Or they may be too exhausted by the illness to have the energy to advocate.
``I know of folks with psychiatric diagnoses who pay for their treatment out of pocket,'' Kelly says. ``They don't want any possibility of their employer finding out. But not many people can afford that for very long.''
The Mental Health Association does lobby legislators on behalf of the mentally ill. A bill that would help ensure patient confidentiality - making employees more likely to use their mental-health coverage - will be reintroduced in the Virginia General Assembly this year.
Complaints about mismanaged coverage or fraudulent payment denials can be addressed to Steven Foster, Commissioner of Insurance, State Corporation Commission, P.O. Box 1157, Richmond, Va. 23209. Call (804) 786-3741 for more information.
For advice on pending legislation, or for more information on mental illness, call the Mental Health Association of Roanoke Valley at 344-0931.
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