MPPA believes that “doctors should recommend and patients (or parents) decide” on their personal health care — whenever possible. Even when patients are civilly committed or judged to be legally incompetent they continue have legal protections which respect their autonomy and right to choose their health care. That is why in part physicians and clinics should post (online) and discuss the costs of health care that they recommended to their patients. Affordability: Care costs should be part of all (non-emergency) doctor-patient discussions and plans. And both doctors and patients need to know what the insurance company or government program will pay — and won’t.
MPPA believes that a Hippocratic (person-centered) physician ethic is a crucial patient protection. We are concerned about current efforts to shift the traditional medical ethic to tasking physicians to be (Platonic) gatekeepers of public (taxpayer) or insurance company dollars. A physician’s person-centered Hippocratic ethic does not conflict with sound public health practices, in fact it enhances it. In our increasingly diverse society It is essential that Individual patients and their families (or designated decision-makers) “decide” their personal health care choices based on their personal and cultural preferences.
MPPA believes that the only payment or reward a clinical doctor can rightly expect from a patient is money for professional services, either in the form of fees-for-service or salary.
We recommend that physicians and clinics post and discuss the costs of health care services they recommend to patients. Unless on the gurney en route to surgery, money issues and costs ought to be include in the respectful language of doctor-patient discussions whenever a patient’s care is being planned.
The Hippocratic Ethic: Doctor-patient alliance and trust is violated when a physician exploits a patient in self-serving ways. In addition to blatant “no-no” behaviors of intimidation, sex with patients, and stealing, MPPA believes that a conflict of interest is present for physicians when a doctor assumes a “gatekeeper” function for health care resources available or withheld when s/he receives payments or enhanced salary for arbitrarily promoting or withholding certain pharmaceutical prescriptions or medical devices without focusing on what is best for the patient before him or her strictly in terms of the patient’s illness and best clinical science.
Things get dicey ethically if a doctor makes money by not caring for patients and/or splits “saved” health care money with other parties — be these insurance companies, clinic administrators, or other health care “providers” — rationalizing this behavior as apportioning scare resources and deciding what is best for a population of patients rather than the patient before him or her. A physician’s professional training and ongoing education are geared to learning what is likely to help and harm individual patients. Yet, best public health practices are totally compatible with this ethic.
Of course money matters in the doctor-patient transaction. Price and cost visibility are crucial protections for both patients and doctors in their mutual work. We believe that the best care outcomes occur when patients have actual power to direct money for their health care and are aware of how resources are to be allocated on their behalf. Patients need to have choices of third party health care insurance that they can keep to protect them from catastrophic expense, regardless of current employment or government economic assistance status. And, patients should be afforded ready access to all legal contracts between their doctors or clinics and insurance companies which involve their care — including how and for what their doctors are paid.
Lee H. Beecher, MD