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Comments

jb

I'm intrigued by your statement that "some argue that radiologists have an ethical obligation to do the procedure [mammography]" I don't recognize any ethical obligation to do anything for or to a patient unless I specifically agree with that patient to do something. Any ethical or moral obligations that any physician may have been under have been replaced by >100K pages of federal regulations, guidelines, and requirements, not to mention what the legal hyenas force us into not doing. Like many docs, in order to preserve my practice, I have to restrict what I do and to whom I do it. I didn't create this problem, but I have to live with it.

CBB MD

JB:

I certainly agree.

However, if you try to explain that to the public, straight up, they won't hear the rest of what you are saying. Then no message gets across.

The public believe that physicians have all sorts of moral and ethical obligations and duties that are ill-defined yet supremely governing of what we do and why. This perception is steeped in a moral soup that originates from a defunct pact we, the doctors, made with patients in an era when we had skills that were little greater than barbering. To obscure what we were unable to do (and to bide us time to explore, discover, and otherwise empirically claw our way into modern medical science), we invoked the whole "art of medicine" ruse and cloaked it in a mysticism that, at one time, had doctors rated second only to clergy in levels of public respect. I think that was a major tactical (and ethical) error of our forefathers. We should have been frank and to the point from the beginning.

This phenomenon was compounded by the system of health-insurance-provided-as-work-benefit that arose during WWII when wages were frozen and businesses needed to attract workers -- so they offered free health insurance.

The presence of "free health care" (it's free when you don't pay for it) combined with the continuing thread of moral obligations and ethical duties has put us between a rock and a stiletto tip. Now that health care is actually WORTH something and is getting REALLY good, the traditional payers are punking out. They don't really care about anyone's health, so, the less care involved, the less expense, the better for them. Since insurance companies, HMO's, private hospitals and the government are not perceived to be morally obligated at anywhere near the same level as the physicians, (who are unable to regulate their own fees), doctors are are chosen to be the moral chumps -- elected to take the fall (and not coincidentally softening up the public for overhaul of the health care system and its MD-profiteers) as payers ratchet down care.


You are certainly correct that we do not have an a priori ethical obligation; however, the public don't believe this and won't buy it. And legislators will not hesitate to use the concept out of context to crucify us.

This is one of the very essential reasons I started this blog. It is the intention of politicians to establish the rubric and rhetoric of a health care crisis -- during what should be the golden age of medicine -- by creating subterfuge that demonizes doctors and blames the health care system for problems intrinsic to society and thus catalyze a system-wide top-down change that we leave you and me, in our senescence (and then our children) at the hands of second-rate physicians trained to palliate and procrastinate while they maneuver us through a health care system that will make the motor vehicle department seem like a Donald Trump Spa. Thank you for reading my blog.

Sincerely,

Tom Boyle

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