Short Story: YOUR HEALTH CARE IS AT RISK
© 2004-2006, Sandra Levy Ceren. All Rights Reserved.

Rick was about to get the shock of his life. After parking his car, he hopped out smiling, eager to share his victory with Lisa, his wife of two years. Rick had won his first product liability suit against a toy manufacturer. The plaintiff, a four year old boy and his family could now pay the medical bills with plenty left over. Rick had reduced his substantial fee, but he wouldn't tell Lisa that part because he was sure she'd be angry. Money was less important to him than to her. Although he knew no amount of money could reduce the pain and suffering from the loss of the child's eye, it made him feel good to be charitable. Too bad Lisa wouldn't understand.

He unlocked the door to their luxurious, rented apartment and switched on the light. Stunned, he gasped at the empty living room. Every piece of furniture had been removed. He dashed into the bedroom. Again, bare except for the contents of his armoire strewn on the floor, his clothes in the closet and his toiletries dumped in the bathroom sink. Lisa and all of her belongings were gone. Rick felt dizzy, nauseated, weak. His world had suddenly, inexplicably collapsed. He hurried into the kitchen for a drink of water. The cupboards were bare. A note scribbled hastily in Lisa's childish handwriting on blue scratch paper clung to the sole remaining magnet on the refrigerator door.

"The firm moved me to San Francisco. We're done. Divorce papers filed. Lisa."

Devastated, he paced the floor. Finally, he crammed a few necessities into a carry-on, collected his briefcase and drove to a nearby hotel. Rick hadn't eaten dinner, but he wasn't hungry. He lay in bed, hugged the pillow for comfort, and wept. He spent a sleepless night, bemoaning his loss and the mystery of his lost relationship.

If Lisa had told him her plans, at least he would have been prepared. There was no prelude to her sudden departure. No clue. He thought they were getting along. What had he missed? No harsh words were exchanged when he told her he was ready for parenthood, but she remarked that she wasn't. There had been no discussion. Case closed. He could not have stopped her from leaving, but maybe she would have explained.

After a sleepless night, Rick struggled out of bed, shaved and stared at his blood-shot, sunken eyes. "Man, you're one ugly dude. No wonder Lisa left. You don't deserve such a gorgeous chick."

Rick couldn't mobilize himself at work. He thought of nothing but Lisa and the mistakes he must have made. He knew his best friend Brian and Cathy once had problems, but they had worked it out.

He called Brian. "I've got to see you. Lisa left me."

They agreed to meet for lunch in a private dining room reserved for business meetings. After the server took their order, Brian asked, "So what happened?"

Between sobs Rick told him.

"Pull yourself together, good buddy. Lisa isn't worth it. Anyone who'd jump ship like that is a pig. To tell the truth, Cathy and I never liked her. Thought she wasn't good enough for you. Come have dinner with us tonight."

"I can't eat and the last thing I want is to be in the company of a happy couple."

"We're your friends, Rick, but okay, I won't push. I think you'd do well to call my shrink," Brian said as he jotted down his doctor's name and phone number.

Back at the office, Rick tried calling the doctor, but the doctor had relocated. Probably retired. Medical people are leaving the profession in record numbers these days because of payment problems, he thought. To economize, Rick's firm recently changed their medical insurance plan from one that had offered free choice of doctors to a new plan-a managed care company that promised big benefits at lower cost plus immediate service.

Rick punched in the number on his health insurance card for mental health benefits and was put on hold for an inordinate amount of time. With every passing second his frustration increased. After five minutes, "Brenda" came on the line. In a pleasant Indian accent, she asked him about his current symptoms. Rick's voice cracked as he described his sleeplessness, lack of appetite, crying, and anxiety over his future.

"I've authorized one session with Doctor Tess Case," Brenda said.

"What's one session going to do?" he asked.

"The doctor must document the need for additional sessions," Brenda replied.

"Document?" His legal mind kicked in and he was horrified. A stranger on the phone had asked him confidential questions, and feeling desperate and vulnerable he had complied. He had heard the clicking of computer keyboard keys while speaking to Brenda. He became concerned over who now had access to this information. "Never mind. Destroy the document, please, " he said before disengaging the phone.

After he regained his composure, he chuckled at the irony of the doctor's name, and realized a remnant of his sense of humor was restored. Although many of the employees at Rick's firm were attorneys, they had failed to investigate the track record of the new plan nor to consider the limitations. They had fallen prey to an evangelical sales pitch. Because Rick was a successful attorney, he could well afford private confidential psychotherapy and he needed more than a few sessions to learn that he had ascribed qualities to Lisa which were not hers, but of his idealized image of the wife he wanted--someone generous, compassionate, and family minded.

Rick had fallen for Lisa's good looks and had taken for granted they would have a family. They had been drawn together because of the familiarity of their shared backgrounds, but that was not enough. They had not discussed their goals and values prior to marriage.

Lisa, a highly paid corporate attorney turned out to be materialistic and selfish. Rick would do better with a mate with whom he shared the same values-a woman who would be proud of his kindness to others. His symptoms quickly dissipated. Therapy helped grow Rick's self esteem and saw him through his next mate choice-a woman worthy of him.

Rick was fortunate to connect with a psychologist during a rough period in his life and to achieve personal growth. But Rick may be in a minority of people--those who could profit from psychotherapy and are willing and able to pay for it.

Despite the public's awareness of the benefits of psychotherapy, the limitations placed by managed care do not permit intensive psychotherapy.

Confidential information once held sacrosanct is no more. Our personal data is computerized, accessible and can be compromised.

Information showing a deterioration of functioning is frequently required before treatment is authorized. Most people who would benefit from psychotherapy are able to function well, but they are in emotional pain and deserve relief. Relief should not always come from a bottle. A clerk, reading from a managed care manual may tell the doctor to prescribe a specific medication--usually cheaper or not always the best for the patient--in effect practicing medicine without a license. Recent studies show that the best form of treatment for depression may be a combination of medication and cognitive therapy.

In many cases the number of authorized sessions is too brief to bring lasting results or to restore functioning. If someone has been carrying around unpleasant baggage for years, it's wishful thinking to expect a few sessions to be significant.

Magic 101 is not in the mental health curriculum. Change takes time. Examine the high rate of divorce, spousal and child abuse, homicide, suicide, violence, substance abuse and the abundance of self-help groups for every malady and you will see the need for psychotherapy. Read Ann Landers.

It is well established that emotional health impacts physical health and work productivity.

We are all part of a network of relationships: friends, family, co-workers, neighbors. Our emotional upsets impacts those close to us--like a spreading virus. A healthy person is an asset. An emotionally unhealthy person can be a liability.

Managed care corporations are in business to make money, If they were to pay for the best care, their executives would be deprived of their unconscionable salaries and huge benefit packages. Marketing their product would be too costly.

Many doctors have difficulty collecting the contracted discounted fee. Many drop off panels because they either do not receive payment for services or they receive a below market fee. These panels become phantom panels. The names of the doctors may remain on the panels, but they are not available to the "insured." Although health care providers chose their profession to help people, they need to support themselves and their families.

A recent Supreme Court decision ruling in favor of HMO's has made the situation worse. Patients cannot sue their HMO's in federal court. If you would like you help battle abuses from these corporations, join The National Coalition of Mental Health Professionals and Consumers. Help protect quality mental health treatment and the patient's rights to choice, privacy, and decision-making power.