Tuesday, May 03, 2005


Cerberus disguised as St. Peter

This morning a patient described a familiar story. Her child has a minor need for special services from the school system. The social worker of the assessment team has informed her that services cannot be provided because her child's needs are below the cut-off level of severity. The mother's experience is that she is on the outside of the team caring for her child and cannot get in. She advocates for her child and is placed in an adversarial relationship with the team that is to provide the services her child needs.

She cannot get past THE GATEKEEPER.

I do not know when the metaphorical gatekeeper idea arose in our society. About fifteen years ago Managed Care turned the patients' best advocate (and best manager of care) into Cerberus guarding the gates of even mundane and routine care. Increasingly, it seems, those who we most trust to be on our side are actually those who deny us what we need. The restrictions are not for the better good of all, but for the financial protection of some system, be it the insurance company or the Board of Educaton budget.

I guess we get what we ask for. We allowed Managed Care to be the prevalent health care payment model. We vote down adequate school budgets. We ask for Cerberus when we want St. Peter.

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