Restoring trust between patient and doctor

Article Abstract:

The economic interests of the physicians often place them in a position of conflict with their patients. To a large part, this results from the current fee-for-service method of compensation for most physician services. Although such conflict of interests occurs in other fields such as law, the interests of patients are more personal and precarious. Consumers understand that they are often exposed to abuse by physicians, particularly those involved in procedure-oriented specialties that are highly lucrative. However, society must take care that in attempts to control the excess of some, it does not destroy the motivation of hard-working, competent doctors who charge fairly. The public must understand that by the time physicians have completed their 7-10 year training period, many are $50,000 to $100,000 in debt. After this enormous investment of time and money, during which time they are usually out of the mainstream work force, physicians expect above-average financial return; failure to receive such compensation should be expected to lead to bitterness and little joy in the practice of medicine. A starting compensation of $100,000 leading to $200,000 seems to be equitable. Doctors are told to expect high incomes after their long and difficult training, for dealing with the inherent difficulties of practice. Doctors should avoid any financial conflict of interest, such as owning medical facilities to which they refer patients, and the fee-for-service basis of medical practice needs to be re-examined. Practice arrangements based on salaries for physicians need to be explored as a more equitable way of compensation and as a means of resolving patient/physician conflict. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physician and patient, Physician-patient relations, Medical fees, column

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"Near Death" - in the moment of decision

Article Abstract:

On January 21, 1990, public television stations in the United States will present "Near Death," a six-hour documentary about the moral and ethical decisions that are involved in maintaining life at the intensive care unit of Beth Israel Hospital in Boston, MA. Although the film effectively presents the day-to-day decisions that are faced by physicians and patients dealing with the provision or withdrawal of life-support procedures to the critical ill or dying, the documentary does not provide commentary. The viewer must evaluate the strengths and weaknesses of the current system and extract the film's lesson. Families are seen dealing with issues relating to the provision of life support or resuscitation. The hard decision not to provide such support is explored. In some instances, doctors are seen to be reluctant to include patients or their families in such decisions, feeling that it would be unfair to include them since they could not make truly informed consent. The issue of the capacity of families to make such decisions is explored in two cases involving incompetent patients. To some degree there is a gap between the theory and practice in dealing with issues of the maintenance of life. Perhaps the film can help close this gap and force policy-makers and individuals concerned with medical ethics to face this issue. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Terminally ill persons, Terminally ill, Ethical aspects, Critically ill, editorial

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Death and the research imperative

Article Abstract:

Doctors may need to abandon the idea that they can defeat death entirely. However, preventing premature death is certainly a worthwhile goal. Any death before the age of 65 is considered to be a premature death. Most research funds should be concentrated on preventing diseases that cause premature death. Making death painless and peaceful is just as important as preventing death. Most palliative care is still given to patients that doctors cannot cure. In reality, it should be given to all patients. Doctors should focus on treating chronic illnesses and functional disabilities.

Analysis

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