Jewish World Review May 7, 2004 /16 Iyar 5764
Drs. Michael A. Glueck & Robert J. Cihak
Fear in the Medical Garden of Eden
Some years ago - a friend tells us - he was attending a large,
fund-raising luncheon: 800 people in the ballroom of a downtown hotel.
Midway through the guest speaker's unremarkable spiel (a presidential
candidate at the time) a woman in the audience started screaming, clearly
in more pain than the droning warranted. Two things happened. Several men,
obviously physicians, started moving toward the stricken woman, each eyeing
the others and doing his best to get to her second. And the speaker,
somewhat shaken, said, "Would someone please call 911." Several hundred
people whipped out their cells.
Then two other things happened. It turned out that the woman, a
prominent local attorney, had been the victim of an accidental hot coffee
pot spill and needed no medical care. And all those people calling 911
crashed the system.
The lady and the emergency line both recovered. What concerns us here
is the reticence of the physicians to attend to a person in distress, for
fear of subsequent legal action, should their ministrations prove improper
or unavailing, or even proper and helpful. For those doctors were showing
symptoms of the greatest unrecognized crisis in modern medicine.
Call it "Refusal to Treat", the deliberate withholding of care.
Today, medicine is everywhere. Health care accounts for one-seventh of
the Gross Domestic Product, a share that will grow as the population ages.
And yet, more and more, "Refusal to Treat" influences the practice of
medicine. Your Medicine Men have written about various aspects of the
problem. But, to our knowledge, no one until now has (as they say at the
9/11 Commission) "connected the dots."
Herewith a sampler of "Refusals to Treat".
Refusal to Treat for personal moral and ethical reasons. Abortion and
euthanasia provide the most obvious examples here. But there are others,
ranging from purely cosmetic procedures ("No, madam, you don't need your
toes tapered so you can wear those ridiculous overpriced shoes") to quiet
unwillingness to comply with various public health mandates, such as
excessive and unnecessary vaccination.
Going on strike, usually in order to protest exorbitant insurance
premiums. This happened in 2002 and 2003 in the South, East, Midwest, and
in the high-profile Las Vegas emergency room shutdowns. The public was
shocked and chagrined. The rates remained high.
Moving out of states where premiums are unbearable or courts
Getting out of the business partly or entirely. More and more
physicians are taking early retirement, fed up with the hassles of dealing
with insurance companies, HMOs, and the government. For the patient it's
also getting harder and harder to find an obstetrician, or a pain
Opting out of the Medicare system, i.e., refusing to treat Medicare
patients because of over-regulation, administrative hassles, and
restrictions upon practice once you take a dime of Uncle Sammy's money.
Sam's regulations run in the hundreds of thousands of pages!
Fear of criminal prosecution. Today, billing the government means
trying to unravel an incomprehensible and often contradictory set of
regulations. Even honest mistakes of no great cash value now invite
criminal prosecution, or at the very least, years of special attention from
the auditors. Pain management specialists have also learned to expect the
DEA's knock on the door at any moment, should some bureaucrat or enforcer
not like the way they practice, or should their legally prescribed
medications end up in the wrong hands.
Two other Refusals to treat stem from the Mother Nature of Things.
Today, much of the health care business seems a bizarre caricature of
capitalism, in which the only way to make money is to withhold the product.
When people pay a set fee each month for potentially unlimited services,
providers quickly reach the point at which they have to start saying No,
usually defined as some sort of new medical "best practice." For example,
many shocked women in the senior ranks write us that their physicians will
not authorize a repeat Pap smear for three years -- since their current
smear is negative.
And finally, state medicine. As America moves toward "single payer"
socialized medicine, we will discover that single payer really means
"single buyer." And when there's only one buyer who controls the market,
you get what they're willing to pay for. And if it's illegal to go outside
the state system - once again, the government will be engaged in the
business of creating criminals where no criminality exists.
And so it is in the aggregate: all those little refusals starting
to add up to one big Refusal. As Lucy once put it in the 1967 Off- Broadway
Theatre 80 play, "You're a Good Man, Charlie Brown," - look at my fingers.
Individually they may not count for much. Together they become a formidable
weapon. In this case one of evil.
"Refusal to Treat" . . . the fist of fear and frugality that's coming
Editor's Note: Michael Arnold Glueck wrote this week's column.
Michael Arnold Glueck, M.D., is a multiple award winning writer who comments
on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute
Senior Fellow and a past president of the Association of American Physicians
and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists.
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