Are doctors who work for health insurance administration breaking the Hippocratic Oath?
Many of these health plan doctors, whose job it is to reject claims, end up being paid to violate the Hippocratic oath they took when they graduated from medical school ““ to “first, do no harm.” The American Medical Association’s position on physicians’ behavior outside the exam room is very clear: “Physicians in administrative and other nonclinical roles must put the needs of patients first . . . . The ethical obligations of physicians are not suspended when a physician assumes a position that does not directly involve patient care.”
Related posts:
- Ordering tests for other doctors
- When will doctors find it acceptable to deny medical services?
- What should a doctor do when he discovers another doctor’s mistake?
- How should doctors handle the difficult patient?
- Medical terrorists
- Health care is not a right: The fight continues in Colorado
- "Doctors, Free Yourselves"
KevinMD.com on Facebook
{ 5 comments }
When we put the correct object of what “do no harm” applies to… that being “the pocketbooks and social status of the providers” then they are doing just fine in fulfilling their “oath.” Furthermore, if there is anyone out there that believes the pabulum of the “oath”… I have a private bank account in Nigeria filled with $400 million and only need your bank account number to wire the money into.
It is not whether one believes the oath or not, but as with any oath, whether one believes in the personal integrity of the person who takes it.
I believe that there is an ethical way to do utilization management, and an unethical way to do it. Ideally it would be unnecessary, but given the reality of physicians who are perfectly willing to provide unneeded but dangerous medical services for their own profit, it is in fact needed.
Since this dialogue revolves around the Hippocratic oath, what is you never actually gave it during medical school.
Then are we bound by this same oath in terms of maintaining personal integrity.
My physician prescribed a medication to treat a nasty toe fungus (there are two available commonly and he chose the best for my case). His wisdom was overruled by my insurer who refused to provide it. Not stated, but obvious, the reason was cost.
Instead they suggested I take the alternate pill (which my doc rejected for a number of reasons, including efficacy and side effects). I could always go out and purchase the medication my doc prescribed out of pocket, yet the whole reason for a health insurance plan is to bring the very best care within reach when it’s needed. I’ve had this health care plan for years and had never considered that my physician’s learned decisions would be second-guessed (and I emphasize the guess part).
I wrote a nastygram to “Dr. Tufts (substitute name of your carrier here) complaining “since when is an insurance carrier licensed to practice remote medicine?”. I demanded: “I want a copy of your license to practice medicine” and asked, “If Dr. Tufts exists, what are his/her/its office hours? The least you can offer is to schedule an appointment to examine my toes”. I even sent on a photo to assist in the “remote diagnosis”. I should have included some snippings for the stink effect.
A copy of my letter was sent to our state Medical Registration Board with a cover demanding that they investigate this case of unlicensed medical practice and interference in my doctor’s decision. (Likely this was posted on an employee bulletin board for laughter).
Within a few weeks the medication was approved.
If Dr. Tufts wishes to enter into the field, he/she/it might consider doing so legitimately instead of through the skanky financial arm-twisting in the ongoing war between insurers and physicians.
When the work of doctoring morphed from community-based medicine to the “system” we have today, it went all to hell. Doctors who want to care, can’t, or have to do it on the sly, and patients who need the best get screwed out of it because they simply cannot afford it. Never mind the horrific mix of the current US politics, medication industry, “heath care” regulation, and a cadre of wealthy and powerful medical associations who are co-enabling and enriching themselves at the great expense of the average patient.
Doctors who have the courage to fulfill their oath deserve encouragement and support. Those who capitulate and make decisions that are not in their patient’s best interest need to be called on it. And finally, insurers who second-guess and put cost considerations ahead of care ought to be legislated out of existence.
Actually in a free society, those insurers would not be legislated out of existence, but driven out of business by consumers who are still perfectly free to purchase indemnity insurance which does not nickel and dime them on such things.
But in fact, when feeling healthy and buying health insurance, people are not willing to pay the premiums that such coverage requires, so that buy from insurers competing on price, and doing so by restricting what they pay for.
Or, they, not wanting to take responsibility for their own choices, have their employer choose insurance from their pre-tax earnings in the form of an employee benefit–giving up responsibility and freedom in the bargin.
The other way to get the insurance company out of your business with your doctor, is to get the insurance company out of your business with your doctor. Buy a catastrophic plan for much less money, and pay your doctor directly for routine care. It is more dignified than make an *ss of yourself and ultimately more effective–and usually cheaper. My deductible + premium is less than my premium was for conventional insurance–so in a worse case scenario I am still ahead financially–and in control.
Comments on this entry are closed.