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The Basic
Problem -
The importance of the doctor-patient relationship Let’s say that one-day, down on your luck and in need of some quick cash, you decide to rob a Seven-Eleven. You rush in brandishing a .38, and order the clerk to hand over all the cash. He turns out to be a wise guy, so you shoot him. You quickly clean out the register and head for the door – where you run smack into two burly police officers who happen to be entering the store right then for some of that good Seven-Eleven coffee. You are quickly and none-too-gently disarmed and arrested. So
there you are – caught red-handed, money in one hand, gun in the other,
the blood of the clerk on your shirt, and the whole thing recorded, in
living color, by a hidden video camera. Now,
here’s the question: What rights are you entitled to? |
Despite the fact that anybody can see how guilty you are, you have many rights. You have the right to a fair trial. You have the right to be considered innocent until a jury of your peers declares you guilty. And you have the right to appeal the verdict (assuming, of course, that you won’t like it).
But most importantly and above all else, you have the right to counsel, an advocate, an individual who is obligated to defend you against all odds, to the best of his or her abilities, and to protect your interests against the world.
Many physicians find themselves envious of the unbending resolve with which lawyers are able to embrace their most basic role of advocacy. Lawyers retain this luxury because society recognizes the legal system to be a morass of rules and regulations which ordinary citizens cannot hope to navigate on their own. Any citizen who becomes embroiled in this morass is universally acknowledged to have the right to a lawyer who is expected to hold that citizen’s interests above all others (within, of course, the constraints of the law). Even those accused of the most heinous of crimes are entitled to legal representation, and even if the evidence against them seems overwhelming, their lawyers are expected to jealously guard their rights. While the rest of us may become frustrated and angry when we observe the rights that accrue to (in our eyes) an obviously guilty party, on an objective level most of us understand the wisdom of such a system. And we shudder to think of the abuses that would occur if these protections were removed.
When you are sick, shouldn't you be entitled to the same protections as when you rob a 7-eleven?
Most of us think so. And the doctor-patient relationship is supposed to see that you are.
Doctors
are expected to fill for their patients the very same role that lawyers
fill for their clients. This
role is necessary, because sick people are no more capable of navigating
the complex health care system than are accused felons the complex legal
system, and are no less in peril if they run afoul of that system.
And a patient’s need of an advocate, a professional whose job it
is to protect the patient’s own best interests, is no less vital than
that of the felon.
Over the ages the doctor-patient relationship has been defined, through rules of ethics and rules of law, as a fiduciary one, as a relationship founded in trust. When a patient seeks a physician’s help and the physician agrees to give that help, a special covenant is made. The patient agrees to take the physician into her confidence, to reveal to him even the most secret and intimate information related to her health. The physician, in turn, agrees to honor that trust, and to become the patient’s advocate in all matters related to her health, placing her interests above all others – including his own personal or financial concerns.
Now,
to be sure, the doctor-patient relationship was never completely pure in
actual practice, even in “the good old days.”
But a strong fiduciary relationship has been what patients have
expected, what most doctors have striven for, and what everyone else (the
medical ethicists, professional societies, and those who write and enforce
the laws of the land) have traditionally agreed – and even demanded –
should be the standard. It
represents the fundamental expectation of how doctors and patients are
supposed to behave toward one another.
Whenever you are a patient, the traditional
doctor-patient relationship guarantees there is at least one
knowledgeable professional who is looking out, above all, for your
interests – not the interests of the insurance plan you’re in, or
of your demographic group, or even of society at large, but the interests
of the individual, you. The loss of such
an advocate, especially at a time when the interests of all the other
parties within the health care system are centered on cutting costs (and
therefore have never been less likely to coincide with your own needs),
would be catastrophic.
Physicians, too, rely totally on the integrity of the doctor-patient relationship, since their role as their patients’ advocate is the foundation of their profession. This role is far more than just an ethical and a legal obligation. It is their duty as advocates that imparts any and all claims physicians may have to the title “professional,” and to the perquisites and considerations that flow from that title. Without this role, physicians are no longer professionals. They truly are reduced to mere commodities in a vast healthcare marketplace.
Thus, the traditional doctor-patient relationship is vital to the professional survival of the physician, and to the physical survival of the patient. If we lose this relationship, we lose everything.
Next - Why we can't have it anymore
Surviving the Health Care System is adapted with permission from YourDoctorintheFamily.com
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