What we do with the auditors

ARE WE GOING TO DO WITH THE AUDITOR?

Emilio Alberto Restrepo Baena

"When you're studying medicine and medical pigeon - told us in his usual sharp and malicious rogue eyebrows narrowed as the unforgettable Professor Tomás Quevedo - all aspire to be surgeons, gynecologists, orthopedists, internists, pediatricians, general, specialists medical or surgical. - I know that in the first half of the race say, my sleep and the strong desire of my life, is to be auditor doctor. "

And in the commentary was always a keen and brilliant observer of reality, lies a naked truth that one of the great problems of medical audit in our midst: The lack of vocation, motivation not to answer existential and academic who tries to make clear the track of utopias and hopes that one fed in their expectations when he studied and longed to be a great expert, ready to serve others under the precepts of the Hippocratic oath.

For it is clear, we see from day to day and suffer in the daily exercise: The vast majority of auditors are doctors, not because they planned it forever, but because there could be medical or surgical specialists, or because did not pass the graduate exam or because the notes were not sufficient or because they lacked the resources required to study three to five years full-time and full time.

This in itself is not bad. Also almost no one wants to be as an adult, a taxi driver or watchman and circumstances of the target is necessary to take such jobs and there are many people who do it with great height, competition, decorum and decency, without detracting from leaving the profession and high representation guild, as long as the work dignifies the human being and should not disqualify productive sectors falling freely in arbitrary generalizations, but it strikes us that in almost all meetings of experts or medical boards or associations or at conferences and medical education seminars, one of the recurring themes, almost the favorite sport is the "throw the auditor?.

Because there is a unanimous concept: Do not understand the fury with which the auditor seeks to specialist as if it were a plague. It is unclear why in the everyday medical procedure the specialist must demonstrate that it is a criminal, that each story is a chronicle of police of a potential theft or irresponsible. Is it perhaps personal motivation of some representatives of a guild against another? Is it a free and resentment into the structure of the profession? Is promoted from the cloisters? Is it pressure from the institutions that pursue only an economic end, forgetting the dedication to service, quality care delivery and the user?

Is it true that there are specific guidelines for some companies providing health gloss as many stories to delay for months to pay the bills? The legend says that a missing EPS gloss ordered consciously and systematically in 90% of the records to delay the obligations and the worst is to believe or assume that doctors are paid for this audit.

Why this distrust recur? Is it just for differences of opinion, or perhaps because of academic shortcomings? Is there anything else to explain the reluctance of auditors to accept the good faith of specialist input that triggered the "Irrelevance" of the physician's discretion?

Because otherwise, how do you explain cases such as not allowing the attention of a child with severe diarrhea and dehydration or purulent tonsillitis fever at midnight for "not considered an emergency," or of a patient with incapacitating dysmenorrhoea in the morning as "a normal colic does not merit priority attention "or deny a mammogram in a woman of 46 years with two sisters with breast cancer" does not find relevance "or paraphrase an account of a patient operated on for acute appendicitis, which resulted in blank laparotomy considering it "a mistake, lack of standard diagnostic" or urgent laparotomy performed on a patient who reported rupture of the follicle with a diagnosis of hemorrhagic cyst income twisted ovary, "no consistency in admission diagnosis of egress" or pretend at all costs to send home a patient hospitalized for evisceration and surgical wound infection, considering that "management can be done at home?, in the impotence of the treating surgeon and the patient's anxiety and their families.

How could a nurse, a bacteriologist or dentist evaluate and audit the records of patients hospitalized for specialists and medical press intend to take that cost behavior, not for ethical or technical constraints, best for the entity they represent. And so a thousand examples taken from daily practice.

At the same time when the insurer requests a "second opinion? supposedly academic purposes, procedure, test or surgery end up doing the same character as always, coincidentally brother or close relative or auditor that problem repeatedly puts us, the little chief dispatcher of the authorizations, or unapproachable, insufferable doctor of yore. When making a claim respectful, arrogance OH, OH pride, "You always generate conflict, one of these days we will have to terminate the contract as they cool things, ask other concept?, Lo and behold, back to the first or at-law.

And there to do when the patient is familiar to them or when there is pressure from some of its leaders, to see if by magic, the way they fill the orders smoothly, as authorized procedures not covered by manuals, and billing codes do not have there is no contradiction or incompatibility or inconsistency. Now that's relevant!

We are not against the medical audit by herself. We believe that the control and rationalization of resources is necessary in light of current health model, but we insist that they are the product of balancing common sense, humanistic values, with the Hippocratic precepts, with the code of medical ethics and a humanitarian exercise, supportive and engaged in medical practice. This would be achieved through stimulating a real academic vocation that is not an audit in cloisters escampadero loosely weekend, but a special sound, coherent, with deep conceptual foundations, academic and ethical to seek to defend our ultimate goal and foremost, the patient and respect our colleagues as was the utopia of our master Hippocrates ruler.

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