Medical ethics
 

Without getting too specific, one of my doctors said they would have to discharge me as a patient if I wasn't wiling to take a cholesterol medication. My objection was that I had taken them for 15+ years but had developed side effects that I am no long willing to tolerate. During that time, my cholesterol was never reduced to recommended levels, anyway.

I confess I don't really understand the doctor's position. Am I not allowed as a patient to refuse treatment? Should doctors have the right to only treat obedient patients who do everything they say?

I don't know the answers. I'm not trying to be stubborn or willfully noncompliant but do feel strongly about this particular issue. I'm curious to hear other opinions from both sides.

I don't agree with the doctor, but I don't think he/she is being unethical. You can always find another doctor.

I know pediatricians who refuse to treat children whose parents won't have them immunized. Of course, part of that reason could be the waiting room problem with other children there. But some of it is about how strongly they feel concerning the subject.

I don't think it's unethical. Perhaps he doesn't want on his conscious the possible consequences of your decision.

I had to find another dentist when the one I had refused to treat me because I would not have xrays.

Unethical is not quite the right word, I agree, but would any doctor really have any liability if I keeled over from a heart attack after refusing a medication? I honestly don't understand why any doctor's conscience would be bothered in that situation. They gave me their recommendation and I ignored it. What else could they have done? If they're determined to feel guilty, I'd think refusing me as a patient and then I keeled over and died would be worse for them, conscious-wise.

It's a cost/benefit analysis for me. Should I be required to take a medication with side effects that may or may not help a condition I may or may not develop?

45% of the doc's in this study dismissed patient because they didn't follow recommendations.

The 7 top reasons doctors 'fire' patients | Advisory Board Daily Briefing

Search the web for something like "web dismiss patient" and you will find many articles about the reason doc's dismiss patients. Basically they say a doc can drop you except in some special cases. If they do they have to facilitate your transfer to another doc but they don't have to find another doc for you.

Terminating a Patient-Physician Relationship | American Medical Association

Insurance companies/medical practices are getting tricky. It may have to do with something called "Best Practices" Certain conditions requires very specific medications to be prescribed for certain medical conditions or very specific guidelines to follow for high blood pressure, for instance. Insurance companies may give the insured a whole brochure of doctors who use these "Best practice doctors " and they prefer you go to them first. In my opinion, it gives the patient a false sense that these are the best doctors to use when actually it is the doctor who adheres to the guidelines put forth by the insurance company or medical practice. All this information is gathered by someone and reviewed. For instance, if a patient of that doctor has documented high cholesterol, the guidelines say that the patient has to be on cholesterol medication. So when your chart is audited, that doctor gets sited for not using best practices even though it is not his/her fault. I don't know all of how it works but this is a general explanation and my facts may not be correct completely, but that is how I understand it. I have gotten the brochures myself of specific doctors to use for any specialty for best practices in the past and get a discount if I use those doctors instead. In the past , I actually don't use those doctors because if I want to get a MRI for a neck problem, a best practice doctor would never order one for me unless I went through more simple diagnostic tests first such a neck X-ray, then Physical therapy, medications etc. If they ordered an MRI as a first step, it would show up on the audit. I am in the medical profession and I sometimes just want to get certain tests done and skip the beginning steps and go right to the best diagnostic test I know that will give me an answer quick. So that may be part of the reason. I don't know how it works for Medicare, as I am not Medicare age yet, but I am sure Medicare has something similar but may call it something different. There is something called HEDIS: Medicare does use HEDIS guidelines. The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90% of America's health plans to measure performance on important dimensions of care and service. ... HEDIS consists of 81 measures across 5 domains of care. It is all very complicated but health care is all carefully tracked and monitored. Not simple like years ago where you and your doctor decided what you needed, instead of the insurance companies.

Huh??? This make no sense to me. If the doctor prescribes a drug and the patient doesn't take it, it is not the doctor's fault. Are you saying that someone who is 100 pounds overweight should not get medical treatment because they just eat too much? Is that the doctor's fault?

This is a fascinating thread. I wonder is some retired docs could post their ideas on this.

Google "The truth about statins!" I argued with three differnt MD's when I refused to take statins. One of those MD's is my son-in law. Finally, my primary care declared me statin intolerant. Check out this link. It sums up my feelings re: statins.

Statin Side Effects (excerpt from Statin Nation) - YouTube

Thanks for the explanation, Brandigirl. That makes sense. This is a newish doctor; my old one accepted that statins didn't work well for me and didn't push it.

To be honest, I miss the days when I'd go to the doctor if I was sick and otherwise we left each other alone. Now it's nag, nag, nag. I'm happy to put some of the blame on insurance company policies.

Oy. I feel you. I showed this doctor a research article from JAMA about myopathy being highly associated with a particular DNA variant* that I have according to my raw data from 23 and Me. He brushed it off. Most MDs tend not to appreciate it when patients roll in with research off the Internet. ;-)


* C variant SNP rs4363657 within SLCO1B1, if interested.

To Retired Guy. You are right, it is not the doctor's fault at all if the patient does not want to follow the advice the doctor gives. I am not sure how specifically it works, but they have people who just gather data. That chart would be audited and it would just show that the patient is not on cholesterol medications and has a diagnosis of high cholesterol. What the ramifications are for not meeting the guidelines ....I don't know. I am also not sure if they just audit the chart and only are looking for a diagnosis of high cholesterol AND if they are/are not on cholesterol medication OR if they look for documentation that the patient refused. If is all complicated but I don't know the finer details. For instance, if you are on a medication for low thyroid level, you have to see your doctor 1x/year in order to continue to get your thyroid medication renewed even if the lab test shows it is in the normal range. As for the weight, for instance, there may have to be documentation that the patient was counseled on weight loss or anyone over a certain BMI would have to have certain other criteria documented in the chart.

My view is that you have the right to fire the doctory if you don't feel he is doing what is in your personal view, what's best for you. He also has the right to fire you if he doesn't feel you are doing what is in his personal view, what's best for you. I also know that families have a tenendency to sue doctors do so I assume there might be some liabillity but most likely, he doesn't want to treat someone that doesn't want to be treated and self diagnoses. Your solution is easy, go find a doctor that meets your treatment criteria.

It is a sad fact that health care providers these days must have "best practices" they must follow, the health care corporation dictates that they must have their diabetic patients under certain control, those with high cholesterol must get their #'s down, etc. At the HMO I worked at, we were given benchmarks to meet and part of our pay was docked if not. So was it my fault my patients chose to continue to be morbidly obese? No, I can't really change their lifetime of bad habits or the fact they have bad genetics. It was a nightmare to inherit another train wreck. Some practitioners resort to doing what yours did in order to make it look as if they had their patients well managed. This is part of the burn out issue you keep hearing about. I've had plenty of patients who either couldn't tolerate statins or didn't work, if they simply didn't want to take them it was my job to explain the benefits and consequence of not doing it. I would never discharge a patient though. If they were blatantly non-compliant, I would mark that on their chart on multiple occasions to protect myself. In your case, I would have written that you have hypercholesteremia that did not respond well to statins and were non-tolerated. To discharge you from his practice is just wrong in my opinion. Unethical? Hard to say.

Just wondering if there are a number of these kind of medications one of which might be OK for you to use?