The Physician Selling, The Patient Buying: Should Patients be Considered Consumers in a Medical Care Market?

It all boils down to autonomy, the principle of ethics that permits the patient the right to make their own medical decisions. But these days, patient autonomy seems to be extended beyond decisions of whether to accept, reject, not start or terminate treatments. Patient autonomy seems to have been extended into areas of clinical decision-making which have always been the responsibility of the trained and treating physician. It has become a patient’s activity to make requests for tests and treatments, essentially selected by the patient from a pool of possibilities not presented by the patient’s physician but by advertisements and the internet and the next-door neighbor. It thus appears that patients are behaving like consumers, entering a market environment with their cash provided by their insurance or government and expecting their physician to provide them with the components of healthcare the patient desires just as the patient will select the items off the shelf or table in that market. And so the physician as expected will follow through on those requests whether it is a procedure, a test or a treatment, irrespective of the physician’s medical opinion. And so the clinically unnecessary and unneeded procedure or drug is provided by the doctor and the cost of medical care continues to rise.

The question is whether this is the way the patient-doctor relationship was supposed to end up, the doctor selling and the patient buying? Wasn’t there supposed to be something different in that relationship? Wasn’t there supposed to be a relationship based on professionalism, mutual trust and both parties, together setting a goal beneficial for the patient but still meeting rational criteria set by the profession of medicine? What do you think?

For more on this topic, read the Op-Ed presentation by Paul Krugman in the April 21, 2011 issue of the New York Times. ..Maurice.

Patient Modesty: Volume 40

So now we move on to Volume 40. I started the thread on patient modesty concerns back in August of 2005--approaching 6 years ago. Much has been written to this thread in the intervening years but I think it is interesting to go back and read the initial Volume of the thread named "Naked"and then compare with the more recent Volumes. I think what you will find is that there has been a shift in conversation about solution to the patient modesty concerns from one of frustration and futility to currently more about some success by patients "speaking up" to their healthcare providers to express their need and even to have their requests satisfied. I look forward toward more optimism than despair or is this just wishful thinking? ..Maurice.

NOTICE: AS OF TODAY JUNE 3, 2011 "PATIENT MODESTY: VOLUME 40" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 41.

Parental Refusal of Vaccination: What Should the Pediatrician Do?

There may be many reasons for parents to refuse a physician's advice to have their child vaccinated for significant diseases which can be acquired in childhood or later. But what is the pediatrician or family physician to do next after the refusal. Certainly the doctor should, after explaining the benefit of vaccination to the child but also the benefit to the community and any realistic risks involved, ask questions to the family about what they understood as the value and risks and then why they are continuing to refuse vaccination. But what if the refusal is not based on some personal financial or some medical or scientifically proven contra-indication but on a religious or some personal idiosyncrasy? Should the physician then discharge the patient from further care and tell the parents to find another physician? Should the physician report the parents to the appropriate governmental child protective agency or the health department? Or is it professional and ethical for the physician simply to accept the refusal as a parental right and continue caring for the child?

If you were the pediatrician.. what would you do? ..Maurice.

Should Physicians be Paid Based on Professional Quality and Cost-Effectiveness Rather than Simply Completing a Job?

Physicians are now paid just for completing some job. The job may be reading an X-ray or treating an infection. The payment is essentially the same whether the job was performed with excellence and contributed to a successful outcome or whether the job was simply performed one way or another. This approach as practiced in the United States may lead to sub-optimal results but at higher costs of medical care. In the era of health maintenance organizations, payment made to participating doctors is based on doing a job which provides the greatest service with the higher rewards and least expense to the industry. In these days with the need to reduce the costs of medical care, thought has been given to having a payment incentive to doctors for not just completing some job but ending up with high professional quality and an ending that is cost-effective. My question is whether physicians should be paid for such performance. That means, if the performance results in a lesser quality, the physician should not be paid or paid less.

Read the article “The Risks of Rewards in Health Care: How Pay-for-performanceCould Threaten, or Bolster, Medical Professionalism” by Matthew K. Wynia, MD, MP in the Journal of General Internal Medicine Volume 24 Number 7 2009 and available at this link:http://www.springerlink.com/content/xq2151wv04r4xx37/fulltext.pdf

Return and write your opinion here on my question. ..Maurice.