Patient Support & Advocacy

5 ways new Title X rule threatens patient-physician relationship

Calling the Trump administration’s changes to the Title X program “the wrong prescription for America,” the AMA has filed a lawsuit to block the implementation of those changes arguing that they would violate the sanctity of the patient-physician relationship by dictating the content of their conversations.

“As physicians, we know that any law or regulation that interferes with or limits our obligation to talk openly with our patients about their health is antithetical to quality care and undermines the patient-physician relationship,” AMA President Barbara L. McAneny, MD, wrote in an AMA Leadership Viewpoints column. “The AMA intends to protect the patient-physician relationship anywhere it is threatened.”

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New federal regulations impose gag rule on physicians, restrict access to critical services

AMA Senior Vice President and General Counsel Brian Vandenberg explained in a Facebook Live interview the harm the new rule could do to patient-physician relationships that rely on trust.

“What the AMA believes—first and foremost—is that the patient-physician relationship is founded on trust and needs to be honored as sacred,” Vandenberg said. When the government injects itself into the exam room, trust is eroded and that’s a slippery slope.”

Vandenberg acknowledged that, historically, the AMA acting as lead plaintiff in a lawsuit against the government is a “somewhat rare action.” But, because—with the new rule—the government is not only limiting what a physician can say to a patient, it is also scripting what they must say, it has crossed a line “so significantly, so profoundly,” that the AMA must step in.

The AMA seeks to have the rule declared unconstitutional. The AMA is seeking preliminary and permanent injunctions against implementing the rule, which is set to take effect this May, Vandenberg said.

Rule blocks a trusted entry point

The AMA’s complaint describes the patient-physician relationship as “sacrosanct,” and also notes that the Title X program often serves as “the most trusted entry point” and “gateway to all other health care” for many low-income women. Because of this, Title X health centers frequently facilitate a crucial touch and the potential for other referrals that otherwise might not have happened.

The lawsuit also argues that the new rule threatens to destroy what has been an “extraordinarily successful” program that has helped women avoid an estimated 800,000 unintended pregnancies and yielded vast benefits in terms of prevention and early detection of cervical cancer and sexually transmitted infections.

This is just one way the new rule would have a negative impact on the patient-relationship. Other examples cited in the lawsuit include:

It creates a conflict of interest. “It will mandate that the speech of physicians and other health care professionals be tailored according to what the government may favor, rather than according to the interests of the patient, best medical practices, or accepted medical ethics,” the lawsuit states. “If allowed to stand, the Final Rule will reinforce a dangerous idea—that physicians and others in the medical profession are to place the interests of government above the interests of their patients.”

The rule requires physicians to disregard patient wishes by banning abortion referrals while mandating prenatal referrals. “Title X providers must not tell pregnant patients how and where they can access abortion safely and legally, but they must provide that information as to prenatal care—again, regardless of what a patient actually wants, or what is in the patient’s best medical interest,” the lawsuit states.

The rule torpedoes a “fundamental tenet of high quality medical care,” which is that physicians must be able to have frank and confidential communications with patients. Leonard Nelson, director of the Litigation Center of the AMA and State Medical Societies, noted on the Facebook Live interview that the rule prohibits physicians from giving straightforward answers to patients’ questions. If asked to provide a referral to an abortion provider, Nelson said the rule calls for providing patients with a list of health care providers who may or may not provide abortion services.

“The physician has to give a list that basically sends the patient on a wild-goose chase,” Nelson said. “That puts a real burden on their ability to find these services and puts a huge impediment on their confidence in the health care system and in the physician-patient relationship.”

The rule has the government replacing the physician in medical decision-making. The rule permits referral in limited instances such as cases of rape or incest or “medically necessary” referrals or “documented emergency care reasons.”

“In sum, the Final Rule not only limits what medical professionals can and cannot say to patients, but also attempts to take the place of the physician by dictating, without ever examining a patient, what is and is not a medical emergency, medically necessary, or comprehensive medical care,” the lawsuit argues.

The rule creates barriers to care and its gag clauses will have harmful consequences to patients. “Forcing Title X practitioners to conceal or distort health care options will inevitably lead to an erosion of patient trust in their providers and the health care system as a whole,” the lawsuit states. “The patient-provider relationship is founded on trust. Once that trust is gone, patients may withhold important information because they no longer feel comfortable sharing it, or simply forgo needed care altogether.”

More resources on the changes to the Title X program, the AMA lawsuit and the fight to protect physicians’ freedom speech can be found here on the AMA website. Physicians are also encouraged to share their opinions on social media using #LetDocsSpeak.