I know this is unethical, but is it illegal?
January 5, 2022 8:30 PM Subscribe
I was shocked to find, when researching a gastroenterology practice to which I was referred, that they refuse to see patients again who have sought a second opinion.
Quite a few negative reviews of the practice mention that the person was dropped as a patient for seeking a second opinion.
I was shocked to see that the practice web site even acknowledges that it is their policy to discharge patients who seek a second opinion, unless the practice was the one who referred them to a second provider.
This is grossly offensive to me and seems to imply that they punish competent adults for the crime of making their own medical choices. It seems to go against the edict that medical providers are to try to help people. Frankly, it seems like the reaction a toddler would have if a friend played with someone else ("Fine, then I'll take my toys and go home!").
Unfortunately I have no choice but to visit this practice because it's the only one in the area that takes my shitty insurance. I cannot express my disapproval by denying them my business.
I have no immediate desire to seek a second opinion, and even if I did I don't know how I'd pay for it outside of insurance, but the fact that this option is denied me does not sit well.
If there is somewhere I can register an anonymous complaint about this, I would like to.
I Googled around a bit and found an AMA medical ethics document that states "Physicians may not terminate a patient-physician relationship solely because the patient seeks recommendations or care from a health care professional whom the physician has not recommended." Does "may not" mean that it is illegal? Against AMA rules such that you may not be a member if you do this? Or what?
I am having trouble reconciling the obvious unethicalness of this policy--and the possible illegality--with the practice's choice to openly admit in writing that they are doing this. Surely they must have received legal advice before putting up the web site text? But how can this be ok??
Quite a few negative reviews of the practice mention that the person was dropped as a patient for seeking a second opinion.
I was shocked to see that the practice web site even acknowledges that it is their policy to discharge patients who seek a second opinion, unless the practice was the one who referred them to a second provider.
This is grossly offensive to me and seems to imply that they punish competent adults for the crime of making their own medical choices. It seems to go against the edict that medical providers are to try to help people. Frankly, it seems like the reaction a toddler would have if a friend played with someone else ("Fine, then I'll take my toys and go home!").
Unfortunately I have no choice but to visit this practice because it's the only one in the area that takes my shitty insurance. I cannot express my disapproval by denying them my business.
I have no immediate desire to seek a second opinion, and even if I did I don't know how I'd pay for it outside of insurance, but the fact that this option is denied me does not sit well.
If there is somewhere I can register an anonymous complaint about this, I would like to.
I Googled around a bit and found an AMA medical ethics document that states "Physicians may not terminate a patient-physician relationship solely because the patient seeks recommendations or care from a health care professional whom the physician has not recommended." Does "may not" mean that it is illegal? Against AMA rules such that you may not be a member if you do this? Or what?
I am having trouble reconciling the obvious unethicalness of this policy--and the possible illegality--with the practice's choice to openly admit in writing that they are doing this. Surely they must have received legal advice before putting up the web site text? But how can this be ok??
That is amazing!
But I think this is at the behest of shitty insurance, yours and very probably others, because if a patient goes there and they refuse to do expensive tests, then the sick and unsatisfied patient and insurance customer goes somewhere else, gets an expensive test or expensive treatment or both, and turns out to be sick, the insurance could be on the hook anyway.
So they just prohibit you from doing that.
So I think your first call should be to the insurance commissioner of your state, because I think this kind of collusion probably breaks regulations if not the law.
posted by jamjam at 8:59 PM on January 5, 2022 [3 favorites]
But I think this is at the behest of shitty insurance, yours and very probably others, because if a patient goes there and they refuse to do expensive tests, then the sick and unsatisfied patient and insurance customer goes somewhere else, gets an expensive test or expensive treatment or both, and turns out to be sick, the insurance could be on the hook anyway.
So they just prohibit you from doing that.
So I think your first call should be to the insurance commissioner of your state, because I think this kind of collusion probably breaks regulations if not the law.
posted by jamjam at 8:59 PM on January 5, 2022 [3 favorites]
Usually the right to have a second opinion under patient bill of rights which you will see in hospitals a bunch. If he's connected you a hospital system you may be able to complain to his affiliated employer through a patient relations department.
CMS guidelines which are essentially all the rules for medicare/Medicaid may have something buried in there.
It is worth the professional board complaint as an ethics guideline violation if you just want to do it, in general they don't make reporting difficult and half of it would simply be sending their website and revelent text which is copy and paste They'll investigate if they want. Honestly though there is some very shady shit that can go on unnoticed, and it's hard to for things to stick when it is reported.
posted by AlexiaSky at 10:53 PM on January 5, 2022 [4 favorites]
CMS guidelines which are essentially all the rules for medicare/Medicaid may have something buried in there.
It is worth the professional board complaint as an ethics guideline violation if you just want to do it, in general they don't make reporting difficult and half of it would simply be sending their website and revelent text which is copy and paste They'll investigate if they want. Honestly though there is some very shady shit that can go on unnoticed, and it's hard to for things to stick when it is reported.
posted by AlexiaSky at 10:53 PM on January 5, 2022 [4 favorites]
Honestly though there is some very shady shit that can go on unnoticed, and it's hard to for things to stick when it is reported.
An area oncology practice recently just suddenly closed their doors without notice, leaving all of their cancer patients in the lurch and scrambling to find other oncology practices (that were accepting new patients) through which to continue treatment. Patients weren't warned beforehand, and weren't so much as given referrals to other practices. Just cut loose and left to fend on their own. Unethical as fuck and totally legal.
posted by Thorzdad at 4:56 AM on January 6, 2022 [1 favorite]
An area oncology practice recently just suddenly closed their doors without notice, leaving all of their cancer patients in the lurch and scrambling to find other oncology practices (that were accepting new patients) through which to continue treatment. Patients weren't warned beforehand, and weren't so much as given referrals to other practices. Just cut loose and left to fend on their own. Unethical as fuck and totally legal.
posted by Thorzdad at 4:56 AM on January 6, 2022 [1 favorite]
Sketchy as F-.
As everybody pointed out, AMA's Code of Ethics says everyone is entitled to a second opinion because it is a patient's right to manage his or her own medical care. HOWEVER, you should contact your insurance first to see if this is allowed. Some insurance is known to REQUIRE a second opinion (and pay for it) for certain treatments. Medicare will even pay for a THIRD opinion if the first two opinions differ. And a brochure by Patient Advocate Foundation states that seven states have actual laws regarding 2nd medical opinion, but did not state which 7 states those are.
posted by kschang at 5:25 AM on January 6, 2022 [2 favorites]
As everybody pointed out, AMA's Code of Ethics says everyone is entitled to a second opinion because it is a patient's right to manage his or her own medical care. HOWEVER, you should contact your insurance first to see if this is allowed. Some insurance is known to REQUIRE a second opinion (and pay for it) for certain treatments. Medicare will even pay for a THIRD opinion if the first two opinions differ. And a brochure by Patient Advocate Foundation states that seven states have actual laws regarding 2nd medical opinion, but did not state which 7 states those are.
posted by kschang at 5:25 AM on January 6, 2022 [2 favorites]
You are correct that that dismissal purely for a 2nd opinion is contrary to established standards. A not-small number of physicians won't co-manage the same illness with another in their specialty, because it creates risks of accidentally combining treatments inappropriately or because insurers won't reimburse both of them. Practices in some specialties will dismiss for "doctor shopping" especially for controlled substance related issues. I don't know about the GI world, but I could see some IBS-IBD centered practices doing that.
However, dismissal for a 2nd opinion may not be part of what is punishable or considered malpractice. Dismissal from a practice is rarely punishable. Physician abandonment is different (not providing adequate notice to obtain care elsewhere) and sometimes can be disciplined or included in malpractice. Where you can effectively lodge a complaint depends on the state that the physician is in. While influential, the AMA is a voluntary body with essentially no power. Many doctors (like me) don't joint because we don't like their political activities. Their guidance (like the code of ethics) might be influential in legal cases where determining standards is important, but it will vary based on location.
posted by a robot made out of meat at 7:56 AM on January 6, 2022 [1 favorite]
However, dismissal for a 2nd opinion may not be part of what is punishable or considered malpractice. Dismissal from a practice is rarely punishable. Physician abandonment is different (not providing adequate notice to obtain care elsewhere) and sometimes can be disciplined or included in malpractice. Where you can effectively lodge a complaint depends on the state that the physician is in. While influential, the AMA is a voluntary body with essentially no power. Many doctors (like me) don't joint because we don't like their political activities. Their guidance (like the code of ethics) might be influential in legal cases where determining standards is important, but it will vary based on location.
posted by a robot made out of meat at 7:56 AM on January 6, 2022 [1 favorite]
This thread is closed to new comments.
posted by slmorri at 8:58 PM on January 5, 2022 [12 favorites]