Sunday, January 28, 2018

Patients Bill of Rights - Time for Version 2.0?

How often do we read or hear, “I have a right to …”   Everyone wants to have his rights respected.  Gun owners, prisoners, civil libertarians, union members, non-smokers, protesters and ordinary citizens all want our rights to be validated and respected.  What happens when the exercise of my rights encroaches on yours?  It is these questions that occupy much of our judges’ time and attention.  These are not easy calls to make.  The fact that so many of our Supreme Court decisions are decided by a 5-4 vote indicates that these issues are controversial, complex and vexing.

While we all pride ourselves here in America on our individual rights, these may be at the expense of our community’s rights.   I don’t envy societies such as China or Russia where the state’s rights are paramount.  But, there is no consensus, even here, as to where to draw the line between protecting an individual and society at large.  Consider how vigorous the debate has been on the tension between protecting individual civil liberties and national security. 

'My Rights Outweigh Your Rights'

If it were true that reading our e-mails without a warrant would prevent a full stadium from being blown up, would we support this?  What if our kids were in this stadium then?

The conflict between an individual’s and the community’s rights is active in the medical arena.  Consider a few examples where one patient’s benefit is at other patients’ expense.
  • Physicians give out free samples of medication to patients, who cherish this giveaway.  The cost of this largesse must be borne by the rest of us who must pay higher drug costs.  Nothing is really free, is it?.
  • A man has a right to ride a motorcycle experiencing the thrill of the open road with the wind blowing through his helmetless hair.   If a tragedy occurs, who picks up the bill?
  • A physician prescribes a biologic treatment for Crohn’s disease.  It costs $2,500 each month and is to be administered forever.  If the drug delivers as promised, which is usually not the case, one individual will benefit.   Should the physician consider how many folks could have been helped if these funds were devoted to influenza vaccines, mammograms or smoking cessation?
  • Salvage chemotherapy is given to a patient who is unlikely to benefit.  The aggregate costs of these kinds of treatments could pay for family health centers in underserved neighborhoods. 
The ethos in the medical profession has been that a physician is solely concerned with the patient in the office, and not the population.  This is how I practice.  But, the argument that physicians should be concerned with the greater good and a fair allocation of finite medical resources is potent and reasonable.  For the time being, my patients understand that my advice is directed to protect only their interests.

When you’re in your doctor’s office, do you want him to be thinking about you or everyone else?



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