Rejecting patients on financial grounds

October 5, 2004 10:06 PM

During tonight's debate the Vice President talked about meeting an Ob/Gyn who screens potential patients and then refuses, for financial rather than medical reasons, to accept those who are high-risk. Is that allowed? In my vast medical law/ethics experience cough*Dr. Abby Bartlett*cough this doesn't sound kosher, but...um...what do the actual rules say?
posted by nakedcodemonkey to law & government (5 comments total)

It may not be something that doctors are generally happy about, but it's increasingly common.

These seem tangentially relevant:
International Code of Medical Ethics: A PHYSICIAN SHALL not permit motives of profit to influence the free and independent exercise of professional judgement on behalf of patients.

AMA Principles of Medical Ethics: VI: # A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care. and IX: A physician shall support access to medical care for all people.

Legally, physicians only have a duty of care to patients they have accepted. Hospitals refuse patients all the time; many emergency rooms "dump" patients, a problem addressed with legislation and regulation but still prevalent.
posted by dhartung at 12:42 AM on October 6, 2004

NCM: I think I know the Bartlet reference of which you speak, and at the time she is speaking of emergency care.

(Heart patient from Iran, "You treat the patient in front of you," yes?)

I've heard similar stories about doctors in Florida thinning their patient rosters by charging an "entrance" fee (although the story was about increasing quality of care by reducing the rosters).
posted by o2b at 9:40 AM on October 6, 2004

Why shouldn't a doctor be allowed to do this? What if the motives weren't fear of a lawsuit but concerns for his/her own skill or a desire to simply limit the effort going into the practice? My former doctor, who I loved, decided to limit his practice, accepting no new patients and phasing out pediatric care. (He was an all-ages family practitioner.) He then moved patients like myself, with chronic complicated health issues, to younger doctors with a stronger network of specialists that they could work with. He now sees only a handful of patients, all of whom are essentially healthy and only need regular checkups.

He did this because he was getting older and was looking to devote some of his energies elsewhere; he'd gotten successful, he owns a beautiful home on a prized piece of Pittsburgh real estate, drives a new Mercedes every year and vacations in Tahiti semi-annually. But he was ready to do something more, and so he scaled back his practice in order to make that happen. I understand that he spent a month last year on an extended Nigerian safari. I think that's completely reasonable.

Even if doctors are chosing to pass up higher-risk patients because of a fear of lawsuits if something goes wrong, that doesn't seem like a problem with doctors and their ethics. That seems like a problem with an overly litigious society and juries that pay up on sympathies rather than facts.
posted by Dreama at 9:49 AM on October 6, 2004

dhartung, thanks, those links are great.

(o2b, yeah, that's the one)
posted by nakedcodemonkey at 10:15 AM on October 6, 2004

Dreama, I'm a teacher who has pulled out of public education in order to focus my time and energy on a niche education market, so I feel my position parallels that of your doctor friend. I don't think medicine or education need to be staffed socialist-style, with all workers giving absolutely everything to absolutely everyone.

That said, in America, education differs from medicine in that for education there is a (theoretical) base-line of service available to all people. Parents of means can send their kids to be educated in exclusive schools, while poor parents have the public schools (for the moment). This isn't the same in the medical field, so the issue of whether doctors should be able to refuse patients based on profit factors is more complicated.

I say we set up a baseline universal healthcare system that can grow if we want it to, and pay the doctors who staff it a wage commiserate with their experience.
posted by squirrel at 9:11 PM on October 6, 2004