The Ethical Financial Dilemma Physicians Face in Medicine

Introduction

Physicians today need to be prepared to face ethical dilemmas throughout their careers. Unfortunately, ethical conflicts and dilemmas are not always clear cut or black and white. As the medical industry continues to evolve and insurance reimbursement models for medical services change with increasing regulations, doctors are having to find new ways to stay financially afloat (“5 Trends in Healthcare,” 2017). The financial burden physicians face can cause ethical conflicts in consequential ethics, patient fairness and medical honesty when treating both insured and non-insured patient.

Discussion

Those who choose to practice medicine, agree at graduation from medical school to meet the standard code of ethics when treating patients. The Hippocratic Oath that most medical providers swear to and hold sacred has been the moral and ethical model for physicians since the time of Hippocrates (“Definition of Hippocratic Oath,” 2016). Physicians must approach each patient with consequential ethics and provide beneficial medical care with beneficial outcomes for the patient (Pozgar, 2016). Physicians must approach each patient with fairness and without personal bias, discrimination or judgement (Pozgar, 2016). Physician must also provide medical care to patients with honorable motives and maintain an honest and truthful character that patient can rely on (Pozgar, 2016). These ethical expectations can become blurry when experiencing financially pressure and burdens. Physicians may find themselves unknowingly breaking their Hippocratic oath in order to stay in business and maintain their practice. Rising overhead, changes in insurance payment models and the high cost of upgrading to electronic health records have pressured physicians to find various ways to increase practice income (Mathews, 2012).

Unnecessary medical tests or excessive medical exams can be used by physician as more of a financial gain rather than used to benefit the actual patient. Over $200 billion is spent on unnecessary medical cost in one year and approximately 21% of current medical care is consider unnecessary (Szabo, 2017). Physicians who order unnecessary tests on patients for financial gain are not only contributing to the sky rocketing costs in medicine but may also be causing harm to their patient resulting in a conflict in consequential ethics (Szabo, 2017; Pozgar, 2016). Patients may potentially suffer from needless pain and suffering from meaningless bloodwork or unwarranted biopsies and may be exposed to avoidable radiation with frequent x-ray or CT scans (Szabo, 2017). This exposure to needless radiation or pain, damages patient trust and weakens the physician’s honorable and trust worthy moral character (Pozgar, 2016). Physicians who order excessive tests with the knowledge of their lack of benefit may not always be pushing ethical boundaries but merely protecting themselves from frivolous liability (Szabo, 2017). Many physicians today fear being sued and are pressured to protect themselves by ordering additional test that may not be always necessary for diagnosis or treatment (Szabo, 2017). Physicians need to work to find balance between maintaining their medical oath, providing appropriate patient care while at the same time protecting themselves from trivial lawsuits.

Ordering an excessive number of tests for financial gain is not the only ethical dilemma physicians face when practicing medicine. Providing equal care for both the insured and non- insured patient can be an ethical challenge of bias and unfair medicine. A 2006 study of twenty- five primary care physicians found that 90% admitted to adjusting their medical care to patients based on insurance status (Jain, 2008). Some physicians have acknowledged that they personally spend less time with non-insured patients and admit to scheduling non-insured patient surgeries at the end of the day so they are the first to get bumped when the schedule runs late (Jain, 2008). Non-insured patients have also been found to receive less preventative care medicine when compared to insured, receiving less routine bloodwork, cancer screenings and fewer recommended vaccines (Jain, 2008). Doctors should always take cost into consideration especially for those paying out of pocket, but an open and honest discussion with patients directly can help minimize bias or unintentional discrimination. Additional possible solutions for non-insured patients could be to offer them reasonable payment plans to help cover cost of routine medical exams and preventative medicine allowing medical care to become more affordable (Jain, 2008).

Direct, open communication is always crucial to maintaining a trustworthy relationship with patients, but additional policies and solutions help to reduce medical financial fraud and insufficient care for the non-insured. Recent insurance policy changes in healthcare have begun the process of reducing the number of unnecessary tests and move toward a more equal approach to medicine. Traditionally, healthcare providers are paid for their medical services through a fee-for-service model which simply pays for tests and procedures regardless of necessity (“5 Trends in Healthcare,” 2017). Today more insurance companies are moving away from the fee-for-service model and moving toward a bundled payment model (“5 Trends in Healthcare,” 2017). The bundled payment model pays providers an upfront payment for a single period of care reducing the expense of unnecessary tests (“5 Trends in Healthcare,” 2017). Currently, the bundled payment model works well for standard procedures but can become difficult with primary care physicians caring for complex medical cases (“5 Trends in Healthcare,” 2017). Other possible models that have proven to reduce unnecessary medical costs is the Choosing Wisely campaign, currently being used at Cedar Sinai Hospital. Through the Choosing Wisely, doctors are alerted when a medical test that does not comply with the 18 choose wisely recommendations; as a result, Cedar Sinai has reduced spending by $6 million in the first year (Terhune, 2017). The ultimate solution may be a combination of everything. Balancing between both fee-for-service model and the bundled payment model in addition to implementing various policies that help guide physicians into making wise medical and financially responsible choices.

Conclusion

Ethical conflicts in medicine will always occur in some fashion, but the financial ethical dilemma physicians face today is avoidable. Most physicians hold their Hippocratic oath as the highest priority when treating their patients. But for the few physicians that abuse the fee-for-service model and intentionally order medical test to make profit can be deterred through changes in the insurance payment model and incorporating new hospital campaigns that help guide physician on what is appropriate testing. Open communication with patients about preventative medical costs and offering patients affordable payment options can help reduce discrimination between the insured and non-insured. The healthcare system is far from perfect but with some moderate adjustments it can be significantly improved for all.