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Treating the Medically Uninsured

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Imagine that you are a physician and the patient sitting before you has no medical insurance. This means, of course, that this individual will have to pay personally for the costs of blood tests, radiology studies, consults with medical specialists, prescriptions, diagnostic tests and even surgeries.  What do you think it might cost your patient if he is suffering from issues such as chest pain, weight loss, abdominal pain or dizziness?  Standard evaluations for these medical symptoms can cost many thousands of dollars. 

Treating the medically uninsured

Medical Care Ain't Cheap

So, assuming you are the doctor, how would you modify your advice to be sensitive to your patient’s sober financial realities? 

Which of the following modifications would you support for a patient who has no insurance?
  • Instead of ordering a stress test for chest pain, prescribe heart medicine to see if this resolves the issue.
  • Instead of sending the patient to the Emergency Room for a question of appendicitis, prescribe an antibiotic and have the patient see you in the office in 24-48 hours to reassess him.
  • Instead of referring the patient for a colonoscopy to evaluate rectal bleeding, prescribe medicine for hemorrhoids to see if this controls the bleeding.
I recognize that compassionate folks – Whistleblower readers – would be tempted to bend their medical advice to spare a patient from financial hardship.  However, if any reader believes that any of the above 3 hypothetical actions are acceptable, then permit me to respectfully point you in a different direction. All 3 responses are entirely unacceptable and unethical.  Here’s why.

A patient’s financial status should have no bearing on the medical advice.  Indeed, to modify it would be a breach of medical ethics and professionalism.   Every patient is entitled to the physician’s best medical advice, regardless of cost or ability to pay.  Sympathy for a patient’s personal circumstances, while understandable, must not taint the medical advice.

The patient, however, may opt to decline the doctor’s recommendation for cost reasons.  This is perfectly acceptable and understandable.

So, if a millionaire or an uninsured person comes to me for advice, I can’t guarantee that my recommendation will be perfect, but I assure you that the advice for each would be the same.


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Comments

  1. Elliot DavidsonJuly 12, 2022 at 5:27 PM

    Insightful as always, Michael. However, I would very to suggest that perhaps this is always not so clear cut and you may participate in some “shared decision making” about what to do next to be effective and as cost aware as possible!

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    1. Michael Kirsch, M.D.July 13, 2022 at 6:47 PM

      @Elliot, well said! And while we agree that such a patient may opt for a compromise of sorts, I presume we also agree that the patient should be informed of what the optimal recommendation is, leaving cost issues aside. Appreciate your thoughts, as always.

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