From the late 1940s and into the 1980s, Edward Rosenbaum, MD, was part of a thriving internal medicine and rheumatology practice in the Pacific Northwest, and he founded the University of Oregon Medical School’s (now Oregon Health & Science University) Division of Arthritis and Rheumatic Diseases in 1950. He was on top of the world—until a diagnosis of throat cancer in 1985 stopped him in his tracks. For the first time, he was no longer in control. Instead of being the captain of the ship—the doctor—he was now just a cork bobbing in the vast, dark sea of the medical system—the patient. The experience opened his eyes to the inhumane way patients are sometimes treated. 

“I have heard it said that to be a doctor, you must first be a patient,” he wrote in an account of his experience titled, “A Taste of My Own Medicine.” “In my own case, I practiced medicine for 50 years before I became a patient. It wasn’t until then that I learned that the physician and the patient are not on the same track. The view is entirely different when you are standing at the side of the bed from when you are lying in it. If I could go back, I would do things very differently in my own practice than I did.”

The CEOs and the other executives of health insurance companies that impose unnecessary regulations on physicians and patients, specifically requirements for pre-authorization for cataract surgery, are a lot like Dr. Rosenbaum in the early ‘80s. I wish there were some way for them to switch places with ophthalmologists for a time, and have to deal with hours spent on the phone with an insurance company in an effort to get authorization for a patient’s cataract surgery, or fill out a mountain of paperwork for a surgery that should be routine, only to have it blithely rejected because a vowel was out of place in a name (and then have to wade through a time-consuming appeals process to correct it). Or maybe they would have to deal with an emergency retinal detachment/cataract surgery procedure in which the cataract gets denied, as recounted by the AAO’s David Glasser, MD, last year when the Aetna pre-authorization program was being rolled out. After going through all this, I wonder if their feelings would change on the matter.

Of course, they will be on the other side of the fence one day: Everyone, if they live long enough, gets a cataract, and becomes a patient. How would the executives feel at that point, when their insurer denies the care that’s been deemed proper by their physician? In fact, maybe that’s what happened in Aetna’s case, considering it has rescinded the pre-authorization requirement for cataract surgery in most states: A member of its board of directors probably developed a cataract and, after 20 minutes dealing with the pre-authorization hassle, said, “Uh, this is stupid. Drop it.” 

Though other insurers appear to be following Aetna’s original lead and initiating pre-authorization requirements of their own, let’s hope they also follow Aetna’s eventual path and scrap them just as quickly. 


— Walter Bethke
Editor in Chief