Skip to main content

The Cost of Treating Uninsured Care - The Whistleblower Weighs In

Image
By

Last week, I posted on whether physicians should modify their medical advice in response to patients who cannot afford the recommended care.  A hypothetical patient was presented who had no medical insurance.  The clinical particulars suggested that a CAT scan of the abdomen was the ideal diagnostic test, but the patient would not be able to afford this.  I, therefore, offered readers several choices of medical advice, some of which was tailored to the patient’s financial situation. 


Here’s my view.   While there is very little in medicine or the world which should be absolute, medical advice must remain pure.  It should depend only upon the physician’s best medical judgment regardless of the patient’s financial situation.   A millionaire and a pauper who present to the doctor with an identical medical issue should receive the same medical recommendation.  Yes, I realize that patients are not interchangeable and that there are cultural, personality and religious differences that may affect the medical advice.  Leaving that aside, every patient is entitled to the practitioner’s best advice, regardless of the ability to afford this care.  If the right advice is an MRI examination, a colonoscopy, surgery or a medication whose yearly cost exceeds his yearly income, then the doctor must advise these options.  While we may feel we are being compassionate and understanding by trying to treat the patient on the cheap, when we do so, we are failing in our healing mission.  It’s not possible for an uninformed patient to provide informed consent. 

The patient will decide what he can afford.  First, it may be possible that he has access to resources that the physician does not suspect.  More important, the choice of rejecting medical advice because of cost is properly the patients’ – not ours.  It is for the patient to respond that he cannot afford the preferred medication and to then ask us what the alternatives are.  It is not for physicians to leapfrog over expensive medical care with the misguided view that we are being sensitive to a patient’s financial predicament.

So, do readers think that I am on the money here?
Labels:

Comments

  1. AnonymousJuly 10, 2013 at 2:35 PM

    Very interesting article. You make a great point- access to medicine should not be a luxury dictated by doctors. In fact, access to medicine should not be a luxury at all. If you wouldn't mind, please take a look at this Facebook page at https://www.facebook.com/HealthWoWealth. It provides some interesting insight on how to make access to quality medicine a reality- an inexpensive reality. Your support would be much appreciated.

    ReplyDelete

Post a Comment

Popular posts from this blog

When Should Doctors Retire?

By
I am asked with some regularity whether I am aiming to retire in the near term.  Years ago, I never received such inquiries.  Why now?   Might it be because my coiffure and goatee – although finely-manicured – has long entered the gray area?  Could it be because many other even younger physicians have given up their stethoscopes for lives of leisure? (Hopefully, my inquiring patients are not suspecting me of professional performance lapses!) Interestingly, a nurse in my office recently approached me and asked me sotto voce that she heard I was retiring.    “Interesting,” I remarked.   Since I was unaware of this retirement news, I asked her when would be my last day at work.   I have no idea where this erroneous rumor originated from.   I requested that my nurse-friend contact her flawed intel source and set him or her straight.   Retirement might seem tempting to me as I have so many other interests.   Indeed, reading and ...
69 comments
Read more

The VIP Syndrome Threatens Doctors' Health

By
Over the years, I have treated various medical professionals from physicians to nurses to veterinarians to optometrists and to occasional medical residents in training. Are these folks different from other patients?  Are there specific challenges treating folks who have a deep knowledge of the medical profession?   Are their unique risks to be wary of when the patient is a medical professional? First, it’s still a running joke in the profession that if a medical student develops an ordinary symptom, then he worries that he has a horrible disease.  This is because the student’s experience in the hospital and the required reading are predominantly devoted to serious illnesses.  So, if the student develops some constipation, for example, he may fear that he has a bowel blockage, similar to one of his patients on the ward.. More experienced medical professionals may also bring above average anxiety to the office visit.  Physicians, after all, are members of...
8 comments
Read more

Electronic Medical Records vs Physicians: Not a Fair Fight!

By
Each work day, I enter the chamber of horrors also known as the electronic medical record (EMR).  I’ve endured several versions of this torture over the years, monstrosities that were designed more to appeal to the needs of billers and coders than physicians. Make sense? I will admit that my current EMR, called Epic, is more physician-friendly than prior competitors, but it remains a formidable adversary.  And it’s not a fair fight.  You might be a great chess player, but odds are that you will not vanquish a computer adversary armed with artificial intelligence. I have a competitive advantage over many other physician contestants in the battle of Man vs Machine.   I can type well and can do so while maintaining eye contact with the patient.   You must think I am a magician or a savant.   While this may be true, the birth of my advanced digital skills started decades ago.   (As an aside, digital competence is essential for gastroenterologists.) Durin...
6 comments
Read more