PROFESSIONConsidering costs and coverage in treatmentEthics Forum. July 5, 2004. Scenario: What approaches promote your patients' best interests? How do you discuss diagnosis and treatment options with patients without knowing what medical services their insurance plans cover, what they can afford, what specialists are in their network, etc? Reply: "The art of necessities is strange, That can make vile things precious." -- William Shakespeare, "King Lear" Complexity can be trying, but also an inviting challenge. Physicians eagerly take on complicated medical problems of their patients. Nonmedical complications of the clinical encounter, such as coverage and paperwork issues, however, are increasingly frustrating. They can be detrimental to strong patient-physician relationships of trust and to the good care we want to provide. Regardless of financial arrangements or the health care setting, promoting the best interests of the patient must be the physician's primary commitment. Easier said than done? Unfortunately, the plethora of health plans and variations in coverage makes it seem so. Suppose the best medication for a particular patient is one that is not covered or that she cannot afford. Should she know that and raise the issue with the physician during the office visit? "Well, doctor, I understand, but I don't think my plan covers drug X." Or would she find out at the pharmacy after she has left the office, leading her to ask, "What do you mean my plan doesn't cover drug X? That's what my doctor says I must have." [...]Full text of American Medical News content is available to AMA members and paid subscribers.
Copyright 2004 American Medical Association. All rights reserved.
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The doctors are in the house
The AMA's House of Delegates is holding its Interim Meeting Nov. 7-10 in Houston, addressing issues such as health system reform and physician payment. Meeting coverage - Slideshow Feature articlesHealth reform review The Massachusetts experience Litigation stress Being sued is personal as well as professional Comprehensive coverage
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Nov. 9 issueHouse option for public plan wouldn't limit physician pay to Medicare rates New database for out-of-network pay set to replace disputed Ingenix system Columns and series
From the vault: 5 years agoGenetic testing issues land in primary care practices Nov. 8, 2004 
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