The Patients’ Bill of Responsibilities

by Susan H

1. I acknowledge and believe that I will die someday. Everyone I love will also die. That inevitable outcome will be factored into all my personal health care decisions.

2. I acknowledge that just because a paid professional might be found to assert that he would have performed differently under similar circumstances, doesn’t mean a doctor or nurse committed malpractice. Judges who are overturned on appeal ought to agree. Politicians who lose elections ought to agree. May my conscience prove a righteous guide, if ever I am tempted to seek money by suing a health care professional; health care is an occupation which does not enjoy the indemnity granted to the legal or political profession.

3. I have never knowingly abrogated my right to NOT sue. If a health care professional presents me with a novel, alternative malpractice event resolution scheme, I will trade my ‘right’ to unlimited pain-and-suffering damage award potential for access to good health care at a fair price.

4. I acknowledge that any self-destructive behavior will have the expected outcome: destruction of my self. I hope that I have the dignity of spirit to recognize uncompensated efforts to help me as acts of loving kindness.

5. I will attempt to maintain my medical information (data relevant to my health assessment) independently. If I don’t do so, I will recognize the necessity for prudent health care professionals to perform redundant studies.

6. I will educate myself about relevant physiology, disease processes, and pharmacology as they apply to my health care. I am aware of research resources available online or at libraries.

7. I acknowledge the relative value of health care provision: designer dresses or sports car tune-ups cost more than life-saving surgeons are reimbursed by Medicare. I acknowledge that medical professionals sacrificed a chunk of their youth, while their peer group was out of school earning money and having fun. I must question my value judgment if I choose to maintain my lifestyle while choosing not to pay for health care rendered.

8. I will understand the costs of my proposed health care beforehand. If insured, I will understand policy terms, and feel confident that amounts I can expect the insurer to reimburse my health care provider are adequate. If I am a cash payer, I must ascertain the costs of service before incurring bills which I could not afford to pay. I understand I have the alternative to attend medical school, and provide my own care.

9. I will attend town hall meetings, write my Congressperson, or practice other means of civil utterance which have impact, and muster as much passion in defense of decent work conditions for doctors and nurse as has been exhibited for benefit of for-profit health insurance companies.

10. I will behave responsibly toward my fellow humans. If I see a human suffering, I will try to help him. I will try to live my life with compassion and empathy in the hopes that at its end, I will not die in shame and regret.

Susan H is a regular reader.

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  • Andrea Morgan

    Excellent, really good points and very well said

  • DocbLawg

    Bravo! I don’t know if I agree with the “legal profession indemnity” part though! LOL!

  • Elizabeth

    “I have the alternative to attend medical school and provide my own care?” Sorry, I’m already racking up debt with LAW SCHOOL and don’t have insurance.That just sounds pretentious and insensitive. Sorry, can’t afford to add med school to that to get me through a cash-strapped time in my life.

    Some people who pay cash now used to be in positions where they had the best insurance and were always “ideal patients.” As for me, I anticipate that when I become an attorney I will again have adequate health insurance coverage. Doctors who assume cash patients are always lazy and negligent could use a reality check.

  • http://duncancross.net Duncan Cross

    Shorter #8: I will be omniscient, knowing beforehand exactly what will happen to me, how much it will cost, and precisely how and when my insurance company will decide to screw me over in refusing to pay for it. And because I am omniscient, I could totally do my doctor’s job better than he could – if I just went to school.

    Shorter #9: Obviously health care reform is about doctors vs. insurance companies. Patients have to pick a side, and don’t actually have an interest in the issue otherwise. If you’re not for doctors, you’re against them.

    Shorter #10: I will be more or less like a doctor, except that I will not expect or insist on reimbursement for any help I provide.

    What extraordinary chauvinism! What kind of doctor is Susan H.? Because I don’t believe for a moment that she’s a patient.

  • Anonymous

    Regarding #8:

    If insured, I will understand policy terms, and feel confident that amounts I can expect the insurer to reimburse my health care provider are adequate.

    Of course, insurance companies seem to do their best at making policy terms hard to understand by medical providers, not to mention those not in the medical or insurance fields. Then add in denials or rescissions that occur for reasons not apparent beforehand (or for no good reason), and it is hard for any patient to really be confident in what his/her insurance will cover.

  • W

    Anon 4:55 makes a good point. During a meeting at work conducted by reps from our insurance provider, some fellow employees and I discovered that although we had the very same coverage, about half were getting lab workups paid in full by the insurer and the rest were paying a significant percentage out of pocket. We asked the reps. They said none of us should be getting fully covered labs and blamed the discrepancy on physician coding mistakes. So…maybe we have the “right” to understand our policies, but I’m not sure we always have the ability (and I feel just as sorry for the doctors who have to deal with this every day).

  • http://www.fitnessrocks.org drmonte

    I had people in my office who’s only job was to deal with insurance companies. They did this every day, and every day they were surprised at the way the insurance companies seemed to endlessly change the rules and reinterpret the rules for individual cases. I don’t think anybody really understands insurance policies – we hope for the best, and often lose.

    What doctor isn’t familiar with the refrain from insurance companies: “Remember, authorization of a treatment plan is not a guarantee of payment.” How can anybody even say that with a straight face?

    I don’t think it is even remotely fair to blame a patient for not understanding what their insurance company may or may not cover or pay for.

    Monte Ladner, M.D.

  • SarahW

    Never sue a health care professional? I will if they are negligent and hurt me seriously as a result of negligence, or commit a battery that results in serious injury – at least just as soon as I would sue someone who hit my car and broke my bones.

  • Classof65

    My husband had an abdominal aortic aneurysm repair. He was just getting to the point where he was beginning to feel “normal” when he was struck with extreme abdominal pain, turned out to be adhesions resulting in an emergency intestinal surgery — ten inches of bowel were removed and the ends sewn back together. He’s healthy now, but the two surgeries took at least two years off his life. Yes, I know the surgeon saved his life, but it would have been nice if we had known a second surgery is often required — surely there is some way to put the intestines back in place without causing adhesions… And we had no insurance so we spent $60,000 that summer for medical care. Now he’s uninsurable. People like us should have access to a “public option” or else we’ll be facing bankruptcy the next time something goes wrong. We’ve always worked hard and had always depended upon employer-provided health insurance, but we’ve both lost our jobs and are in our early 60s — five more years before we can sign up for Medicare, assuming it’s still around then.

    There have to be other options for people like us. Or should we just shoot ourselves and get out of everyone else’s way?

  • medstudent

    Sacrificed our youth? No one made us go to med school! Yes, its hard, but I chose this over various other options… if you’re smart enough to get into medical school, you’re smart enough to succeed in another career. I wouldn’t switch places with my friends who already have “real” jobs, or my friends at other graduate schools. Lets remember how lucky we are to be in the roughly 50% of people of all applicants who get accepted!

  • Nuclear Fire

    “surely there is some way to put the intestines back in place without causing adhesions”

    Uh, no.

  • http://askanmd.blogspot.com/ Doctor D

    Seems more like a “wish list” than real responsibilities. I can only guess this is a physician who sacrificed a lot only to be hurt or let down by a lot of her patients. I have had many days I felt like this.

    I’m not sure this is a list of responsibilities we really want to ask of our patients. I don’t think I could agree to do all this as a patient.

    I don’t want patients to have unrealistic expectations of me. I’m not sure having these unrealistic expectations of patients helps the situation. Patients often come to me because they feel terrible. I can’t expect them to be interested in making my life better.

  • Outrider

    >>3…. If a health care professional presents me with a novel, alternative malpractice event resolution scheme, I will trade my ‘right’ to unlimited pain-and-suffering damage award potential for access to good health care at a fair price.>>

    Most injured patients are not looking for a “payday”. What they want is honesty, good medical care that resolves the problem caused by the physician’s error, and assurance that measures have been taken to minimize chances of the same error being repeated. This requires that the physician behave with some integrity and, probably, apologize for harming the patient.

    That will require a radical change in behavior on the part of physicians.

    >>8. I will understand the costs of my proposed health care beforehand…. I understand I have the alternative to attend medical school, and provide my own care.>>

    My plan has many exclusions, because I am self-employed. The last physician I consulted, employed by a very large institution, could not determine what my insurance would cover even after his insurance specialist contacted the company with repeated specific requests.

    And, well, I decided to attend veterinary, not medical school. Though if I had attended medical school I’d have stellar health insurance, rather than the crappy individual policy I had to purchase… the most comprehensive with the lowest deductible available in my state, but it’s still a crappy policy with many exclusions.

    No one has mentioned that physicians, like politicians, generally have outstanding health insurance policies.

  • Mike

    “No one has mentioned that physicians, like politicians, generally have outstanding health insurance policies.”

    This is just not true. Many have to negotiate with insurance companies the same as other small businesses to obtain coverage for the doctors and employees. Many are independent contractors who have to obtain insurance on their own at the same prices as other private consumers. Many choose to pay less and have only catastrophic plans.

    Doctors get sick and have pre-existing conditions just like the regular population.

    Many people in every industry have “outstanding” health insurance policies.

  • CB

    I realize this is just venting “among the boys/girls,” but the gross naivete and snide, combative attitude behind #8 is why physicians being sued have be all but bound and gagged by their defense attorneys. If a hint of that comes out on the stand, the facts won’t matter: the entire jury will delight in lynching the doctor. Plaintiff’s attorneys would be fools not to learn how to needle a doctor, if it will elicit that kind of response.

  • Dr. Dredd

    With all due respect to medstudent, I think he/she should wait until he’s had some real world experience before judging the rest of us.

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