Blog | Thursday, August 15, 2013

Whistleblower weighs in on the cost of uninsured care

Last week, I posted on whether physicians should modify their medical advice in response to patients who cannot afford the recommended care. A hypothetical patient was presented who had no medical insurance. The clinical particulars suggested that a CAT scan of the abdomen was the ideal diagnostic test, but the patient would not be able to afford this. I, therefore, offered readers several choices of medical advice, some of which was tailored to the patient's financial situation.

Here's my view. While there is very little in medicine or the world which should be absolute, medical advice must remain pure. It should depend only upon the physician's best medical judgment regardless of the patient's financial situation. A millionaire and a pauper who present to the doctor with an identical medical issue should receive the same medical recommendation.

Yes, I realize that patients are not interchangeable and that there are cultural, personality and religious differences that may affect the medical advice. Leaving that aside, every patient is entitled to the practitioner's best advice, regardless of the ability to afford this care. If the right advice is an MRI examination, a colonoscopy, surgery or a medication whose yearly cost exceeds his yearly income, then the doctor must advise these options. While we may feel we are being compassionate and understanding by trying to treat the patient on the cheap, when we do so, we are failing in our healing mission. It's not possible for an uninformed patient to provide informed consent.

The patient will decide what he can afford. First, it may be possible that he has access to resources that the physician does not suspect. More important, the choice of rejecting medical advice because of cost is properly the patients', not ours. It is for the patient to respond that he cannot afford the preferred medication and to then ask us what the alternatives are. It is not for physicians to leapfrog over expensive medical care with the misguided view that we are being sensitive to a patient's financial predicament.

So, do readers think that I am on the money here?

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.