The current practice of medicine has become a much more complex endeavor than at any point in history. Not only has modern technology impacted the practice of medicine, but physicians now have to deal with issues such as government intrusion which has made things quite challenging.
Physicians are being told what procedures they can and cannot perform by a group of people with no professional medical training, namely government bureaucrats working in the Medicare system. The United States government’s Medicare program became effective in 1967; it was supposed to help senior citizens get medical care. Although it now costs ten times more than initially predicted, many feel that it has helped elderly patients significantly.
However, how much harm does it do? Government and academic researchers back away from even asking such a question. Recent events show how Medicare is destroying trust between patients and doctors in the name of cost cutting, fraud prevention, and other tangential items.
What about the issue of cost cutting? In 1999, Medicare unilaterally determined that two different blood vessel examinations to evaluate the risk for stroke would be ‘bundled” if the examination were done on the same day. When the two examinations were done on different days, the government would allow $32.10. However, if the examinations were done on the same day the government would allow $16.05. As a result, patients began getting nasty sounding letters from Medicare telling them that their neurologist, Lawrence R. Huntoon, M.D., Ph.D., of Jamestown, NY broke the law by charging more than $0.00 for his services. Only a government bureaucrat could believe that charging more than zero could be a sound way to run a business or could get away with such libel. Dr. Huntoon, president of the American Association of Physicians and Surgeons (AAPS), fought back, but nevertheless felt he was losing the case because of the bureaucratic mudslide and engulfing him in a legalistic mess. Each set of bureaucrats, in turn, disobeyed the Medicare law. Some falsely told him that their decisions could not even be appealed. However, Dr. Huntoon’s struggle fighting back against the bureaucrats finally succeeded. He showed over and over again that Medicare officials had been disingenuous or had outright lied to him, and just this past summer, the Medicare bureaucrats bid a hasty retreat.1
After one year of hearings and appeals, Dr. Huntoon was finally vindicated. The government finally agreed that the doctor’s examinations were indeed worth $16.05 rather than $0.00 and that the lower level bureaucrats were wrong. Dr. Huntoon spent several hundreds of hours fighting this battle so that his patients would have the option of having these clinically necessary examinations. If the zero value had remained, many patients could not be examined.
The bureaucrats backed off only after attorneys threatened legal action and then only when ordered to do so by higher level Medicare bureaucrats. Although it is against the Medicare law for “any federal officer or employee to exercise any supervision or control over the practice of medicine”, the bureaucrats have a glossary of excuses to tell patients and doctors what they can and cannot do. The way the laws are written, bureaucrats make the final rules. When the government wants to ration medical care, it cuts the resources (both goods and services) going into the medical system. When the government’s own policies bankrupt hospitals, insurance companies, and doctors, these government bureaucrats accept no personal responsibility. Instead, they blames others. Dr. Huntoon says that he now spends half of his time seeking coverage and justice for his Medicare patients. Medicare does the most severe damage by destroying patients’ trust in their own physician.
While Dr. Huntoon’s appeal was winding its torturous way through the system, Medicare wrote many of his patients and told them that he was guilty of a crime because he charged more than $0.00. These false accusations were made even before the doctor had been found guilty. This libel destroyed many patients’ trust in their own doctor.
This loss of trust causes many patients to delay treatment while they seek another physician. As a result, many patients undergo needless suffering. Medicare should stop micromanaging health care. The right to make medical decisions should be returned to patients and their physicians. Medicare patients should be given the option of choosing which kind of insurance to buy and how much to spend on it. Real Medicare reform should not make patients and physicians subject to the whim of Medicare (government) bureaucrats.2
It is difficult, if not impossible, to enter into any discussion of the doctor-patient relationship without broaching the subject of informed consent. Informed consent assumes that a patient will receive all the information that he or she needs in order to make a decision regarding whether or not to undergo a particular set of tests or a particular operation. This assumption is based upon the belief that there will be a dialogue between the physician and the patient and that a course of action will take place as a result of said dialogue. Informed consent’s implicit demand for joint decision making confronts the painful realization that even in their most intimate relationships; human beings remain strangers to one another. One can only know and understand another to a limited extent. However, the problem runs even deeper. One can only understand oneself to a limited extent. The latter impediment powerfully reinforces the former, making it even more difficult to know another.3 It is very difficult, if not impossible, for a patient to maintain trust in a physician, especially if this trust is undermined by a government agency.
Another issue facing physicians which was not an issue only a few years ago is the role of “third party providers” (insurance companies), particularly health maintenance organizations (HMOs). Traditionally—and romantically---the family doctor not only cared for the whole family but functioned almost as a member of the family. He cared for the parents, delivered their babies, and saw grandparents through their last illnesses. Delivering these services, he knew what it was to venture out beyond the office and hospital setting. He made house calls, drank family coffee, and savored its gossip.4 Today, most patients not only do not experience their doctor, known to many as the ‘primary care physician’ (PCP) as a member of the family, but they are fortunate if they can see him or her for more than ten minutes during a routine visit. Third party providers, in an effort to improve cost efficiency mandate that physicians see a huge volume of patients on a daily basis. The following words of wisdom from third-party patients are offered as feedback to third party dependent physicians: 1) “Hi…how are you?...see you next time…” does not constitute a clinical history. 2) That stethoscope hanging around your neck looks quite professional; however, would it be too much trouble to put the earpieces in your ears when you listen to my heart and lungs? 3) What exactly does it mean when you say that would be the best treatment, but I cannot have it? 4) What is a 99213 and is it terminal? and 5) Doctor, would it be possible to slow your speech to the point where the sound comes out at the same time as your lips move?
If a physician can recognize one or more of these pearls in his or her practice, perhaps it is time to consider a more ethical, Hippocratic form of practice: third-party free practice. Unless, of course, the physician really enjoys treating incidental patients and practicing bureaucracy instead of medicine.5
1)L.R. Huntoon “Abuse, Lies, and Audio Tape” Medical Sentinel 2000: 5(4):121
2)Robert Cihak and Michael A.Glueck “Medicare Destroying Patient-Doctor Trust” Medical Sentinel 2000:5(5)172,184
3)Jay Katz The Silent World of Doctor and Patient (MD: Johns Hopkins U. Press, 2002) p. xlv
4)William F. May The Physician’s Covenant: Images of the Healer in Medical Ethics (PA: The Westminster Press, 1983), p. 38
5)L.R. Huntoon “Pearls from the Third Party Patient” Journal of Amer. Physicians and Surgeons Vol. 11, No. 3, Fall 2006
6)Francis Peabody “The Care of the Patient” 88 Journal of the American Medical Association 877 (1927)
7)Gabrielle M. Kotoski declaration as part of a civil action Hall et al. v. Leavitt and Astrue U.S. District Court: District of Columbia (12/2008)