Posted on August 19, 2009

Physician-patient relationship should be sacrosanct


By Syed Quadri
Guest columnist
The News Enterprise (Elizabethtown, Ky.)

I have watched with interest the debate over health care reform unfold in the columns of your newspaper and the rest of media. The airways and the pages of every newspaper in the country are saturated with several buzzwords. “Rationing,” “socialized medicine,” “federal bureaucracy,” and “government takeover of health care” are the names that appear to be driving the discussion and creating the frame of reference for the “debate.”

Allow me to share with your readers my experience with the health care system relative to one concern, of increased federal bureaucratic interference, that has been expounded by the opponents of President Barack Obama’s plan to reform the health care system.

I am a general internist and have been practicing internal medicine in Hardin County for the past 11 years. As an internist I specialize in treating medical conditions of adults and especially the elderly. About 50 percent of my patients are covered by Medicare, and the rest have private insurance, Medicaid or self-pay. I am sure everybody is aware that Medicare is a government program operated by the federal bureaucratic agency of the centers of Medicare and Medicaid services.

I have had approximately 30,000 clinical encounters involving patients with Medicare insurance, and the decisions made during these medical visits were never, not even on a single occasion, questioned or rejected by federal bureaucrats. Never has the shadow of a federal bureaucrat even remotely intruded on the intimate space of the physician-patient engagement. I have the full freedom and Medicare patients have the full freedom and broad choice to avail of all reasonable medical tests and pursue necessary treatment without seeking anybody’s permission.

In contrast, the clinical encounters involving patients with private insurance are different. Many of the clinical decisions that result from that encounter are scrutinized, some are rejected by the insurance company, many are grudgingly accepted but only after considerable effort and time has been expended in explaining and convincing the corporate lackeys the merits of doing a test or prescribing a treatment.

When I decide to order an MRI scan of the knee for a Medicare beneficiary to explore for a cartilage tear, my office staff simply schedules the test. On the the other hand, in that same situation, every private insurance company requires that permission be obtained for the test to be done. A corporate bureaucrat can deny the test a doctor has deemed necessary.

It takes me two minutes to admit a Medicare beneficiary to the hospital from my office and up to two hours to admit a patient with private insurance with that amount of time required to obtain permission from the insurance company’s clerk. Once the patient is admitted to the hospital the continued need for hospitalization will be determined not by the doctor but by corporate bureaucrats.

The core principle of medicine is that the physician-patient relationship is sacrosanct and no other agency or entity should attempt to intrude into this special ground or endeavor to influence, alter or abridge the decision that a patient and physician arrive at after an informed discussion. Among insurances only Medicare, an entity managed by federal bureaucrats, honors and abides by this principle, while the denizens of blue-blooded corporate America in their various insurance incarnations with no regard to medical ethics or any ethics trample upon this ideal every day.

The public should rightly be incensed at any effort by a third party to intrude into the privileged realm of a medical transaction or hinder the ability of the physician to freely exercise his professional judgment, but the outrage would be misdirected if it is aimed at the federal bureaucracy. Contrary to popular belief it is not government bureaucrats who seek to restrict the freedom of the patients and physicians alike but it is their counterparts in the private health insurance sector who relentlessly seek to modify, abbreviate and at times nullify a physician’s considered opinion that was formulated in the best interest of his patient.

Surprisingly the shenanigans of the private health insurance bureaucracy have escaped the public’s attention while the phantoms of federal bureaucratic interference have captured the popular imagination. I hope that public opinion will be infused by the bright light of facts and not be inflamed by the passionate heat of irrational emotions in discussing this important issue of health care reform.

Syed Quadri MD, FACP, has practiced internal medicine in Hardin County for 11 years.