The Lebanese-born former American oncologist Farid Fata committed one of the most malicious acts of greed by a medical professional in recorded history.
Fata spent six years telling otherwise healthy people that they had cancer and needed immediate chemotherapy. He then fraudulently billed over $34 million in charges to Medicare and private insurance companies. Fata will arguably spend the rest of his life in prison, but the financial, psychological, and physical damage dealt to his patients and their families will never be undone or repaired.
I find so striking about Fata’s story that none of these patients, who underwent the grueling and agonizing chemotherapy process, bothered to seek a second opinion. This anecdote highlights a major problem with how we are managing our health care system: Many patients do not ask for a second opinion. I won’t assume knowledge in the case of Fata’s patients as to why they never chose to do so. I can only state my own observation: Patients are being conditioned not to ask for second opinions.
One patient I know in particular calls this the “I’ll spit in your food” principle. Just how one does not want to agitate the personnel who handle your food at a restaurant. One certainly does not want to agitate the person involved in managing something as delicate as their health. Often in medically underserved areas, many patients fear losing relationships with their physicians if they ask for a second opinion.
And they are justified in their concerns.
Citing the essentialism of trust, many physicians, often practicing for underserved populations, make it explicit that if their patients seek another physician’s services, they will terminate the relationship of care.
If you live in a medically underserved area, there is arguably only one or two specialists who can diagnose and treat rheumatology, pulmonology, etc. Termination of care in a medically underserved area means getting your health care from providers who are hours and maybe even days away from you. This leads to patients delaying treatment, delays in communication, and poor disease vigilance, among other problems.
Aside from the clear violation of the AMA’s principles of medical ethics, which lists the right to a second opinion, any policy that discourages a patient from doing so should be viewed in the larger context of public health and behavior, and thus should be absolutely discouraged by medical ethicists and lawmakers.
Perhaps one day, we will have a Miranda rights analog for patients in the health care system. Whereby patients are informed immediately as part of the physician’s standard operating procedure, in the most explicit manner possible, upon receiving a diagnosis that they have the right to a second opinion, without, of course, termination of care.
Robert Trent is a graduate student.
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