Tuesday, August 26, 2014
When doctors break the law
I’m a law abiding blogger. Laws are meant to be obeyed. If an individual opposes a law in a free country, then he should operate within the system to modify it. I recognize that even in free societies, certain laws are so unjust and in violation of natural law that that the citizenry may be justified in relying upon other measures to affect necessary reform. I’m not suggesting that an unwelcome federal tax on gasoline be greeted with pitchforks in the street. However, our own democracy is a nation where slavery, “separate but equal,” exclusive male suffrage and Jim Crow discrimination were all legal. In such cases, can we expect a legislature to strike down unjust laws that it enacted?
Law and medicine are increasingly intertwined today, and more than they should be. Physicians no longer practice unfettered from legal encroachments and regulations. I am not referring here to the unfair medical malpractice system, a subject that has occupied a substantial portion of real estate on this blog. Look what Obamacare has wrought and what it threatens to do in the future? Private practice medicine—my gig, for example—will either be declared illegal or will be deprived of oxygen and put to sleep.
The most ludicrous intersections between law and medicine are when legislators try to play doctor for crass political reasons. This is nonsensical as even trained physicians can’t agree about medical testing and treatment. Medical experts, for example, are not of 1 mind on when mammography should be offered and at what intervals. I don’t fault our profession for failing to achieve a consensus here. The science behind the issue is not certain and differing and valid interpretations are expected. I admit here that some of these physician opinions may be politically tainted for reasons of self-interest, but even non-partisan and objective medical experts may simply interpret data differently.
When there is an important controversy in medicine, it should be addressed by additional medical research or accepting an interim position based on the views of medical professionals.
So do you think that the mammography controversy should be settled by doctors or a legislator submitting a bill that mandates mammography coverage starting at age 40?
If we allowed it, politicians would pass all kinds of medical care treatment and testing laws to curry favor with various interests groups. This might be good fertilizer to cultivate some votes, but is this how we want the practice of medicine to advance?
Ohio passed a law earlier this year that would require physicians to inform women facing mastectomy about options for breast reconstruction. The aim of the bill is to assure women that future reconstruction would be a covered insurance benefit so that they would be more likely to accept mastectomy.
Of course, I want these women to be informed of the reconstruction option. Indeed, this is the responsibility of the treating physician. I object, however, to a law that requires it. For those who support such a law, why only breasts? Surely, laws could be passed affecting every medical specialist and every organ of the body mandating certain medical advice. I advise my patients who have reached the 50 year mark that they should pursue colon cancer screening. I don’t think a law should be passed mandating this conversation, but it’s no stretch to imagine a pontificating populist politician from trying to do so. I’m not taking any chances. I’m buying a pitchfork, just in case.
This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
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