Tom Emerick
Posted 3/17/12 on Cracking Health Costs
A huge medical ethics divide exists today among doctors.
In one camp, the ethic is that if a treatment may help someone, let’s do it. This is the prevailing medical ethic in the US. This sounds reasonable, doesn’t it?
However, there is a higher medical ethic practiced by only about 5% of doctors in the US today. The higher ethic calls for doctors to work with the patient to determine the desired outcome, then use the safest and least invasive treatment to achieve that desired outcome. If doctors would follow this higher ethic, we could eliminate a huge amount to back and heart surgery and billion and billions of wasted dollars. Further, fewer patients would be harmed by unneeded surgery.
Which ethic do you want? The one that uses surgery when non-invasive treatment will get the same result? What informed patient would make that choice?
Do you want (1) evidence-based medical care? Or (2) one doctors opinion? I’ll take option 1 every time.
In Reason.com Dr. Jeffery Singer has written an opinion contrary to mine. If you care to read it click here. He writes, “For centuries, my predecessors and I have been inculcated with what has come to be called the ‘Hippocratic Ethic.’ This tradition holds that I am ethically required to use the best of my knowledge to recommend to my patient what I consider to be in my patient’s best interests—without regard to the interests of the third-party payer, or the government, or anyone else.” [Italics mine.]
The problem is for many doctors today their “best knowledge” falls woefully short of science-based medicine.
Care And Cost 
I read Singer’s article & think he isn’t considering that we overscreen, overtest and then have unnecessary procedures all over the system due to inaccurate test results/readings. False positives for cancer are a big driver of unnecessary costs. The tests themselves are ridiculously expensive and patients have a hard time today telling a doctor they don’t want a given test. I shouldn’t have to argue with a doctor about NOT getting a screening – especially when I have no family history of a given condition & my parents & grandparents all live into their 90s with no incident. Personally I don’t want certain treatments that are proven to have dismal results if I get a serious condition – I’d like to choose what course of action to take (I guess the veterinary approach according to Singer). I feel we’re kinder to our pets than we are to our people by not continuing to make them suffer through treatments when deemed terminal. I’d like to have an option of controlling my own death if I think the situation is hopeless – I’m not sure there aren’t others who would agree.
There is a further connotation in Singer’s piece that his considered opinion is superior to the wishes of his patient. There are many physicians who would agree with Singer. When that fact is considered alongside the nugget that physicians would choose differently for themselves, we get a glimpse of the us-them divide that might exist in physicians’ thinking. They may be under the impression that most patients would not know how to choose and the doctor’s recommendation, without any consideration of patient preferences, is superior to any other alternative. However, when it comes to their own health, they expect to be a part of the decision process as if their choice were more valid because they are patients with an MD behind their name. I would not want practitioners like Singer anywhere near me or my family. Yes, I would also choose option 1.