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.