MPPA believes that “doctors recommend and patients (or parents) decide” on their personal health care. Even when patients are civilly commitment or legally incompetent they continue have legal protections which respect their autonomy. Physicians and clinics should post (online) and routinely discuss the costs of health care that is recommended to their patients. Money issues and care costs should be part of (non-emergency) doctor-patient discussions and care plans.
A Hippocratic (person-centered) physician ethic is a necessary patient protection. MPPA believes this traditional ethic is necessary for physicians rather than tasking physicians to be (Platonic) gatekeepers of public (taxpayer) or insurance dollars. The Moreover, the person-centered Hippocratic ethic not only does not conflict with sound public health practices it enhances it. In our diverse society, It is essential that Individual patients and their families (or designated decision-makers) can “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 is money for his professional services to patients, either in the form of fees-for-service or salary.
Physicians and clinics should both post and discuss the costs of health care they recommend to patients. Unless on the gurney or en route to the ER, money issues and costs should be part of the language of doctor-patient discussions.
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, a conflict of interest is present when a doctor assumes a “gatekeeper” function for health care resources potentially available to or withheld, and when s/he receives payments or enhanced salary for promoting or excluding pharmaceutical prescriptions or medical devices not only based on what is best for the patient.
Also, things get dicey ethically when doctors make money by not caring for patients or splitting health care money with other parties — including insurance companies or other providers– rationalizing this behavior as apportioning scare resources and deciding what is best for a population of patients. A physician’s professional training and ongoing education are geared to learning what is likely to help and harm individual patients, and also what are good public health practices.
Since money really matters in the doctor-patient transaction, and this is crucial, protection for both patients and doctors best occurs when patients have actual power to direct money for their health care. Also, patients need to have choices of third party health care insurance that they can keep, regardless of current employment or government economic assistance status. And, MPPA strongly advocates patient access to all contracts and with insurance plan enrollees.
Lee Beecher, MD