Friday, January 2, 2009

Ethical Question? Or not?

Let's pretend you are a medical doctor, or dentist, or eye doctor.

A patient comes to you for an exam. The patient lost their health insurance when they lost their job two years ago. The patient is healthy and has been a patient of yours for several years, so you have access to medical history. They are strapped financially and cannot afford the full array of "tests" that you are recommending. These tests are "preventative" tests ie: if the patient is a woman, it's time for a mammogram....or maybe heart disease runs in the family, so you want to test for heart disease.

The patient says, "I understand the importance of the tests, but the reality is that I can't afford all of them. I can't afford X test, but I can afford Y test. Let's just do Y test."

As the patient's doctor, what do you do?

1.) Do you turn the patient away for ALL care until they agree to do all tests?
2.) Do you only do the tests that the patient can afford, thinking that SOME care is better than no care?
3.) Is this an ethical question or a financial question?
4.) Who has the right to determine the care that a patient receives? (Remember, insurance companies are not involved with this situation).

I know you will have more questions, but this is all the information you get. As the doctor, what would you do? I'll give you the full story tomorrow and tell you what actually happened. Because unfortunately, this is a real story.