What are Medical Ethics and how can we protect the consumer?

Health care providers of all disciplines usually recite the Hippocratic Oath upon graduation. I did in 1981, however do they become just words like redundant, memorized prayers? Are too many physicians following a path of corruption for the dollar, or just rushed and do not reflect on what these words truly mean? I will discuss some of my experiences of gross breaches of medical ethics. Most of these breaches of ethics boil down to money, some are negligence and plain laziness and others, well….empathy, true empathy for patient care has been lost or maybe it was not there to begin with. Following is the up-dated version of the Hippocratic Oath as I recited with my classmates in 1981:

Hippocratic Oath:

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

In 1978 the famous book, “The House of God” was released. A satirical account of a medical student rotating through a hospital on the East coast. Specifically, the account was about a Harvard medical student, plodding through the tribulations of the emergency room. I read this book many years ago, however what struck me was the acronym (GOMER) Get Out of My Emergency Room. It is mostly focused on a patient, frequently elderly, with multiple diagnoses, as well as multiple medications and a rather complex case. It is still used today although many find it unprofessional. I wonder why? Maybe, because it is. My father at the age of eighty, with atrial flutter, hypertension, status post stent, and on a plethora of medication would be refereed to as a GOMER. Ethical? Not a chance. The term has now been carried over to cover many diagnoses, the dying cancer patient, the Parkinson patient, the homeless with head trauma and others.

Medicine has changed drastically since I left Physician Assistant school in the early eighties,and graduate school in psychology in the late eighties. Some advances have been amazing and a plus for the patient. The downfall is that physicians complain often about practicing defensive medicine to avoid getting sued. What led them down that path, if that path truly exists. THEMSELVES ! Over time there has been a gross disregard for patient care, insurance companies often deny testing and treatment as their own pockets and bank accounts become filled with greenery. You know the kind. The stuff that gives many the illusion they are successful or that they are somebody. As the patient may get sub- par care, or be taken advantage of, or their insurance company will be milked for testing that is not needed. I hope to educate the reader here on  a few atrocities to be on the lookout for.

In my thirty years of practicing medicine as well as psychology I have witnessed some awesome providers, fantastic care and have seen the patient and their families reap the benefits. Then there are the atrocities. The blatant “taking advantage of the system because of a God like complex.” I should say a “Satanic like complex.” God would have more compassion.

What are ethical atrocities in Medicine?

The following are all areas in medicine I have witnessed first hand. The atrocities have to do with greed, being rushed, or just plain lack of empathy.

An elevated blood pressure should never be rapidly decreased in an urgent care clinic or in an outpatient setting. Some of these reasons are fairly obvious. Risk of the blood pressure bottoming out, not being able to control it over time, and should the blood pressure bounce back into a dangerously high range one can increase their risk of stroke or heart attack. I have witnessed a physician teach me how to poke a hole in a gel cap of Procardia and place drops under a patients tongue so we could drop the blood pressure just to pass a DOT examine. An exam for the Department of Transportation. The patient passes the exam, the clinic keeps the company happy so they keep sending patients back and the driver keeps his job. Unethical? Highly !

If you are getting sutured in an office and the suture material breaks, a new pack is opened and that suture material breaks. This should raise a red flag into the quality of supplies being ordered.

My father was stung a few years ago by over one-hundred and fifty honey bees. He went to his family doctor’s office where he was treated by the local physician assistant. No stingers were removed, he was given a steroid injection which was appropriate, however was not asked to stay for observation. The kicker is….his vitals were never taken. No blood pressure, no pulse and no temperature. This is unethical and dangerous. There was no baseline blood pressure, no baseline vitals. Ask for your vitals to be taken, you want to know. What is your blood pressure, and what is your pulse.

If you have to go to a clinic for a FFD, Fitness for Duty exam. This would imply you were injured, or may have had surgery and were off work for awhile. Your company may want you to go in and be cleared. NO fitness for duty exam should last less than five minutes. If this happens the clinician either does not give a damn, or is getting pressure from the powers at that clinic to push the patient along. Be alert to this.

Some urgent care clinics have increased prices for “after hours.” The clinic is open for eight, ten or even twelve hours but they charge more because it is after five or seven o’clock. Really? How can they charge after hours when they are already open for a longer period of time. Now, do not get me wrong, they are a private company and can charge whatever their “tiny” heart desires. For myself it seems to walk that ethical line.

Ordering tests before seeing the patient can makes sense. There are times when strep tests, influenza swabs may be in order. This becomes slightly complicated. Is there a recent epidemic of influenza? Is strep very prevalent during a certain period of time? For example, it is perfectly acceptable and makes clinical sense to order a urinalysis on all women with abdominal pain before being seen. The clinician may need to rule out stones, infection, and pregnancy. When a clinic always orders x-rays before seeing the patient, strep tests always before seeing the patient, or influenza screens before seeing the patient, this should raise a red flag.

What patients are not aware of, are the behind the scene unethical behavior of many hospitals, and clinics. Increased bonuses for providers who up-code charts, increasing a reward system for getting patients in and out quickly, keeping certain fractures in house when they should be referred to orthopedics. The potential for bad outcome always exists. This is NOT putting the patient first but putting the pocket book first.

I now work at an awesome ethical, “patient care” first clinic. I have found in thirty years of medicine this is sadly a rare occurrence. As a clinician and consumer I am asking you to be aware. Observe for some of these atrocities. Check your bill, compare, ask questions. It is your health, and your pocket book. You owe it to yourself.