Monday, March 9, 2009

Medical Ethics?

Medical ethics is not an oxymoron but it is fair to say that it has been neglected and requires constant vigilance when your life is at stake. Why? Because doctors are human beings, just like politicians, lawyers, bankers, and corporate executives. The good old revenue stream is highly valued by most of us.

values revisited

In saying this, I am not indulging a grudge. I really like my family doctor and I have also encountered a cardiologist and a bone surgeon whom I respect. However, I am trying to be objective about this vitally important subject. There are a number of areas in which I have noticed that medical ethics seem to be distressed.

PHARMACEUTICALS. The great pharma companies spend more on marketing than on research and marketing means a lot more than distributing valid information to doctors. In particular, it means contributing to the incomes of doctors directly through sponsorship of meetings, lectures, and directed research. Recently, it has been reported that about 279 professors and lecturers at the Harvard medical school have received income from Pfizer or Merck. All of us are also targeted by direct TV advertising to the public. This type of public relations is not noted for its scientific objectivity. While some prescription drugs are life savers, there is the danger of widespread over prescription and over use.

MEDICAL MALPRACTICE. This is a complex subject because even the best of doctors can make mistakes. However, the best of doctors make many fewer mistakes than the worst of doctors and the policing of the doctors' ranks is not very well thought out. Hospitals also make mistakes, which is to say that their medical staff members make mistakes. The number of deaths and injuries in US hospitals caused by medical mistakes has been variously estimated at roughly 100,000 per year. Remarkably, the opponents of universal health care in the USA have placed an ad in which medical mistakes in countries which do have universal health care are pointed out. What callous indifference to fact!

DELIBERATE WITHHOLDING OF INFORMATION. Sometimes doctors, particularly surgeons, will not advise a patient that his condition can be better treated at another place, where the skills, experience, and facilities are better. This is likely to be true in difficult cases, such as rectal cancers, in which unnecessary colostomies may be performed.

BILLING. This is a jungle because of the confused and sometimes chaotic condition of the US medical care delivery system. Medicare beneficiaries are the lucky ones because of federal oversight. The rest of the paying population is vulnerable to being fleeced. Consider a surgery patient in the intensive care unit of a US hospital. He is unable to communicate because of sedation and a tracheal tube. He is temporarily under the care of an "intensivist" who is in charge of the ICU, and whom he has probably never met. Nevertheless, the hospital permits the intensivist to bill him as an individual client. If he is uninsured, the bill will be vastly more then an insured patient's bill. If he is insured, the doctor may claim to not be a "participant" in that particular insurance carrier's plan, even if the hospital does participate - or, there may be a disagreement between the doctor and the plan as to his participation. The hospital may disclaim any responsibility for the billing practices of its physicians. The hospital's own charges will also be vastly inflated for uninsured patients. Some of this overcharge is allegedly caused by the obligation to care for the needy. It is not clear why, if there is such a social obligation, the cost of it must be born by the uninsured patients rather than by the public treasury. Agricultural subsidies, for example, are paid for by the public treasury and not by agribusiness. It may be just a matter of political muscle, because even states with smaller than average populations have two senators each.

Information on these subjects may easily be googled with the right key words.

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