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Is the new professionalism and ACP's new ethics really just about following guidelines?

The Charter ( Medical Professionalism in the New Millennium.A Physician's Charter) did not deal with just the important relationship of ...

Monday, June 25, 2012

AMA joins the "gangwaggon" to guilt doctors to become stewards of society's resources

Kudos to Dr Doug Perednia,author of the blog Road to Hellth, for his denunciation (see here) of AMA's latest egregious attack on traditional medical ethics which is a sell out of both physicians and patients. They join the bandwagon,(gangwagon) initiative to destroy the traditional physician-patient relationship which had already been rocked by the alarmingly successful attack from the New Medical Professionalism-New Medical Ethics spearheaded by the folks at the ACP and ABIM and some of their internist colleagues in Europe.

Dr. Perednia quotes Med Page regarding AMA's actions.

CHICAGO — Providing effective medical care includes an “obligation” to prudently manage healthcare resources, according to a report approved by the American Medical Association’s House of Delegates on Monday.

In fact, managing healthcare resources “is compatible with physicians’ primary obligation to serve the interests of individual patients,” the report reads. It further states that considering the welfare of only the patient currently being treated when making recommendations does “not mesh with the reality of clinical practice.”…

So the obligation (whenever the hell that obligation came from) to manage healthcare resources seems to preclude "considering the welfare of only the patient currently being treated".

Are they are throwing the fiduciary duty of the physician to the patient out of the window?Patients seek medical help to get the best advice for their given condition not to engage in some self sacrificial exercise in forgoing the optimal treatment for the nebulous and undefinable good of society . How much concern do you think a worried parent in the physician's office with a sick child cares about some abstract conservation of society's resources or furtherance of social justice.

In contrast to the gobbledygook of such phrases as "doesn't mesh with reality of clinical practice" and the gratuitous assertion of an operationally meaningless obligation. and the unwarranted assumption that physicians all have a collectivist philosophical mindset, Dr. Perednia makes these valid arguments:

The first principle is that, in Western democratic cultures, when any of us seek out a physician for care, our primary goal is finding a solution to our own particular medical problems rather than a cure for the ills of society. In this role and in our minds, a doctor is supposed to be the equivalent of our “medical lawyer”:

  • We provide the facts of the case as we know them.
  • Our physician is supposed to gather any other relevant evidence and, using his special knowledge, outline all of the possible courses of action we might take and suggest the one that is most compatible with our goals and the resources available to us.
  • He is supposed to looking out for our best interests rather than the interests of others. When a doctor or lawyer takes your case, he is supposed to be working for you: not your opponent, not insurers, not government, not world peace or society as a whole.

The New Professionalism brainchild of ACP and friends did not quite say that social justice and the equitable allocation of scarce medical resources was an ethical obligation of physicians but the New Ethics Manual of the ACP made it explicit. It was a definite ethical game changer.See here for earlier comments on that development.

With many (most) professional medical associations mindlessly signing on to the New Professionalism and now with the AMA imprimatur I have little hope that the next generation of newly minted physicians will enter the field inculcated with the (now obsolete) notion that the physician's primary and fiduciary duty is to the patient.

I offer the following in partial proof on this fear as one "leader with ideas" has suggested
that "cost-consiousness and stewardship of resources be elevated by the ACGME and the ABMS to the level of a new seventh general competency." In other words, residents should be schooled and graded on their mastery of the skill set necessary to be good stewards of [society's] resources. ( reference, The Idea and Opinions Section, Annals of Internal Medicine,20 Sept 2011,Vol.155 no.6, by Dr. Steven E. Weinberger,of the American College of Physicians.

What could be more advantageous to the HMOs,ACOs and medical insurance companies than to flimflam the medical profession into accepting an new ethical paradigm that conveniently coincides with the bottom line of those organizations?

The concept "physicians as stewards of society's medical resources" is , in one sense a meaningless abstraction, and in another, a useful fiction. Useful to the HMOs,ACOs and insurers who now can enjoy to a much greater degree than before, physicians working to bolster their bottom line but decreasing costs also known as providing less to patients.

The socially conscientious physician might feel somewhat at loss as to how he might carry out the massive,pretentious and ambiguous task of stewarding society's resources.He should feel reassured ,though, because all it will take will be "follow the guidelines" and by doing so he will do what it right for that patient and for society as a whole. Wasn't that easy.

1 comment:

Andrew_M_Garland said...

Waiting to Save Money on health care
(At the link, see the link at the upper right)

MedClerk:  Okay now. We will schedule your cancer surgery 15 weeks from now. This will save precious national health resources.
Jim:  How does that delay save money?
MedClerk:  You might die in the meantime and not need surgery.

Lack of resources or a shortage of doctors can increase waiting times. Further, some parts of the UK health service have discovered that long waits save money for the "system".

09/06/11 - Daniel J. Mitchell

The Telegraph UK - National Health Service makes patients wait "to lower expectations".
=== ===
[edited]  At least 10 primary care trusts (PCTs) in Britian have told hospitals to increase the wait to treat patients, to save money.

Some patients endured delays of 12-15 weeks after their doctors decided on surgery, although hospitals could have seen them sooner. The allowed maximum is 18 weeks.

One manager said "short waiting times create more demand for treatment". An NHS watchdog suggested that long wait times cause patients to remove themselves from the lists "either by dying or by paying for their own treatment". PCTs have gamed the system, using maximum limits to delay treatment.
=== ===

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