Doctors Finally Admit to Bedside Rationing

We have long held that doctors, pressed to cut costs by insurers on one side and the Feds on the other, on pain of losing their professional viability or gaining prison (respectively,) are flagrantly engaging in widespread covert rationing.  And a chief method of covert rationing is "rationing by omission" - that is, failing to disclose to patients the full range of medical options available to them.  Now, at last, we are pleased to report a new study that confirms this assertion.

The study, appearing in the July/August issue of Health Affairs, is a survey of 720 American doctors from across the country, who were asked whether they actively withhold pertinent information from their patients regarding optimal medical treatment, because they believe the patients' health plan will not cover that service.  Nearly one third of the doctors admitted to doing so, and of these more than one third said they withheld such pertinent information more often than they did a few years ago.  (DrRich adds that in surveys such as this, in which individuals are asked whether they are behaving in some reprehensible manner, a good rule of thumb is to at least double the percentage of positive responses.)

In an article about this study appearing in the AMNews (the AMA's weekly newspaper,) staff writer Damon Adams interviews a host of medical ethicists and physicians, all of whom express shock - shock - that doctors would behave thusly, in utter violation of universally-acknowledged medical ethical principles.  Susan Pisano, spokesperson for the American Association of Health Plans (the major lobbying group for the nations' health insurance companies - the guys who pull out all the stops to ensure that doctors will do precisely what this study confirms they're doing,) goes so far as to assert that AAHP officials "actually find it difficult to believe that that's going on."

The authors of this study note that "gag clauses," contractual language in which managed care companies prevented doctors from discussing uncovered medical services with their patients, while common in the 1990's, are no longer used.  So, they conclude, gag clauses aren't the reason doctors are deciding to withhold information from their patients.  Docs are "rationing by omission" on their own volition.

But, as DrRich pointed out long ago, when doctors were originally presented with contracts containing the gag clauses, they signed.  When faced with a decision of whether to honor their ethical obligations to their patients, or to honor financial obligations to those entities who actually pay them, they threw their patients overboard.  This is old news.  Whether the gag clauses exist today or not, the point was made years ago, and this study doesn't tell us anything new.

DrRich continues to find it sadly amusing that, presented with data like this, medical ethicists actually struggle to find an explanation for physicians' behavior.  Apparently they still do not see that the entire medical-industrial complex is bent to the effort of destroying the doctor-patient relationship, and that this effort has been hugely successful.

August, 2003

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