New Study: Docs deceive their patients 

In a recent meeting of the Society of General Internal Medicine, results of a 1998 survey were presented that suggest physicians are now in the habit of withholding information on useful but uncovered services from their patients.

The survey was reported by the chief  investigator, Matthew K. Wynia, MD, MPH.  Dr. Wynia is a medical ethicist, and is the director of an academic research unit at the AMA.  Over 1100 practicing physicians were surveyed in this study.  Thirty-one percent said that over the past year, they sometimes had intentionally failed to offer services that they considered "useful" because the patient's insurance would not cover those services.  And over 79% said they used such a strategy more often in 1998 than they had 5 years before.

The same doctors who had withheld information on potentially useful services from their patients tended to report recent attempts by their patients to have them lie to their insurance companies in order to obtain coverage.

Dr. Wynia speculated that for these doctors, withholding information may have been a means of avoiding such requests.  Constraints on doctors' time may also be a reason for failing to disclose certain useful medical services.  Despite expressing sympathy for such problems, Dr. Wynia stated that that nothing justifies a doctor holding back vital information from patients.

DrRich comments:

This study - which documents the widespread nature of "rationing by omission" - merely confirms the major tenet of our Grand Unification Theory of Health Care.  Namely, the health care system has organized itself to ration care by coercing doctors into abandoning their fiduciary commitment to their patients.  The only surprising thing about this study is the high proportion of doctors who admit to this kind of violation of the doctor-patient relationship. 

Of course, it is not appropriate for patients to ask doctors to lie to insurance companies, either.  No doctor should ever intentionally deceive an insurance company (though a substantial proportion has also admitted to this offense.) For one thing, such an action is now a federal crime, with all sorts of horrible and career-ending punishments attached.  For another, deceiving insurance companies maintains the fiction that everything is all right.  It would be more useful to point out the inequities in insurance coverage, and work to fix them. The appropriate action, both ethically and practically, would be fully disclose all useful and potentially useful options to patients, coaching them in legally obtaining those needed services, and working to see that such useful services are covered for everybody.

But, as Dr. Wynia says, that just takes too much time.  Whatever the ethical niceties, doctors are only human.  

And more and more, therefore, patients are on their own. 

The bottom line is, if you are a patient, you'd better become an expert on whatever diseases or disorders you have or think you may have.  The best defense is to come to the doctor's office armed with all the information you can find.  If your doctor knows or suspects you have thoroughly researched "your disease," he/she would be foolish to withhold information from you.  An educated patient is the best defense against rationing by omission.

For a more in depth discussion of what you can do to protect yourself in a dysfunctional health care system, see Becoming a More Effective Patient.

09/02/2000

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