Skip to main content

Treating the Medically Uninsured

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.


Comments

  1. 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!

    ReplyDelete
    Replies
    1. @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.

      Delete

Post a Comment

Popular posts from this blog

Why Most Doctors Choose Employment

Increasingly, physicians today are employed and most of them willingly so.  The advantages of this employment model, which I will highlight below, appeal to the current and emerging generations of physicians and medical professionals.  In addition, the alternatives to direct employment are scarce, although they do exist.  Private practice gastroenterology practices in Cleveland, for example, are increasingly rare sightings.  Another practice model is gaining ground rapidly on the medical landscape.   Private equity (PE) firms have   been purchasing medical practices who are in need of capital and management oversight.   PE can provide services efficiently as they may be serving multiple practices and have economies of scale.   While these physicians technically have authority over all medical decisions, the PE partners can exert behavioral influences on physicians which can be ethically problematic. For example, if the PE folks reduce non-medical overhead, this may very directly affe

Should Doctors Wear White Coats?

Many professions can be easily identified by their uniforms or state of dress. Consider how easy it is for us to identify a policeman, a judge, a baseball player, a housekeeper, a chef, or a soldier.  There must be a reason why so many professions require a uniform.  Presumably, it is to create team spirit among colleagues and to communicate a message to the clientele.  It certainly doesn’t enhance professional performance.  For instance, do we think if a judge ditches the robe and is wearing jeans and a T-shirt, that he or she cannot issue sage rulings?  If members of a baseball team showed up dressed in comfortable street clothes, would they commit more errors or achieve fewer hits?  The medical profession for most of its existence has had its own uniform.   Male doctors donned a shirt and tie and all doctors wore the iconic white coat.   The stated reason was that this created an aura of professionalism that inspired confidence in patients and their families.   Indeed, even today

Electronic Medical Records vs Physicians: Not a Fair Fight!

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.) During college, I worked as a secretary