Much of what we hear about Obamacare these days comes from the perspective of patients, consumers and those tasked with trying to make the insurance infrastructure work. The news, to put it charitably, has been almost uniformly dismal. But the place where the rubber truly meets the road in this equation is the office of the caregiver. How do doctors think things are going in terms of delivering services and providing the quality of care their patients need?

This article from the Post-Gazette in Pittsburgh is worth a read for anyone but you might want to keep a tissue handy to dry your eyes. Even in situations where a patient has insurance through one of these new programs and a doctor they like, they can’t always get the tests and treatment they need. In the case of this particular patient, the arcane rules of the billing system prevented her from finding out for nearly a year whether she had an easily treatable infection or a potentially deadly cancer.

After a patient’s pelvic exam Pap test results came back abnormal last January, the next step medically called for a procedure to determine whether the abnormal cells indicated a treatable infection — the most likely possibility — or something more serious, including a developing cervical cancer.

Ten months later, gynecologist David Deitrick said his patient is still deciding what to do.

The problem is the patient’s insurer, one of the national carriers in the Pittsburgh market, says her plan does not cover the procedure if it’s done at an outpatient surgical center.

She could have it done at Jefferson Hospital in Jefferson Hills, where Dr. Deitrick sees patients, but then her bill would be hundreds of dollars more, including facility fees and other hospital-related costs.

So she waits — hoping either to convince her insurer to change its mind or to save enough money to be treated at the hospital. Dr. Deitrick’s office checks in with her monthly.

The real tragedy here is being experienced by the patient, obviously, but imagine the frustration of the doctor who wants to schedule the test and get the patient started on the appropriate treatment program, but is left waiting while weeks and months slip away. This type of story showed up in the results found in the seventh annual national “Great American Physician Survey” conducted by the Physicians Practice journal. Their findings show doctors who see the state of American healthcare going in the wrong direction. (Emphasis added)

40.5 percent said higher deductible payments and patient costs “represent the largest barrier to patient care,” followed by the simple high cost of care at 20 percent, for a total of 60.5 percent pointing to finances impacting patients’ care.

Third-party interference was their “biggest frustration with being a physician, according to 37.4 percent of the respondents, more than double any other reason cited.

And, while physicians split about evenly on whether the federal Affordable Care Act has been mostly good or “a disservice” for Americans, the growing challenge of collecting deductibles was the most common reason given for how the ACA had affected their practice.

Why is this type of tale so common? Yes, we apparently have a significant number of additional people who have health insurance after the passage of Obamacare, but the ability of people to navigate the system, pay all the deductibles and out of pocket expenses and put it to productive use is suffering. And the doctors seem to sense the same thing. I’ve no doubt that they all got into the business for the purpose of helping people, not acting as a paper pusher in a frustrating maze of A.C.A. system requirements.

If less than two in five doctors think the current state of healthcare in America is satisfactory, what is that telling us? But there is no plan on the horizon to address this.