Your Opinion of the State of Medical Ethics

Discussion in 'Politics & Current Events' started by DoctorJones24, Jan 7, 2011.

  1. DoctorJones24

    DoctorJones24 Member

    Aug 26, 1999
    I was visiting family this week, and my brother in law is a cardiologist finally getting into private practice down in FL after years of expensive schooling and fellowships.

    He mentioned that he was dismayed by the behavior of his 5 partners in his practice--all older docs--he's the new hire with the fancy tech skills on the newest machines.

    Some of the practices he mentioned that clearly border on criminal, or at least downright unethical:

    - Most of his partners openly ignore their hospitalized patients in favor of spending more time at the office. Office visits are more profitable, especially if they can work in stress tests which are apparently a goldmine for cardiologists. So when my bro-in-law does his daily rounds at the hospital after spending the morning in the office, he also checks on his partners' patients, and gets berated by angry family members: "What's going on? Dr. Smith hasn't been by in 4 days!"

    - All of his partners abuse stress tests. One in particular has a blanket policy of ALWAYS giving a stress on every new patient. Regardless of symptoms. And it's worse. He also a blanket policy of ALWAYS ordering a cath as a followup to the mandatory stress test. Both are cash cows, but the cath is also more invasive and can lead to complications. Apparently stress test results are by definition fairly vague, so there's always wiggle room to allow for a rec of a cath. However, the partners considered buying a new test machine that would replace the stress test, and that doc said "No way. It's too black and white, if you know what I mean." Basically, he wouldn't be able to order caths on people without reason anymore.

    - Another doc who isn't certified to read some type of particular scan (forget which) does it anyway. He lets the X-ray tech (an associates degree) go ahead and write up the report, and then the doc signs it as his own. My understanding is that he can then charge a hefty fee for analyzing the scan.

    - There's also just a general tug-of-war in the cardiologist community, apparently, over who gets to give the highly profitable stress tests. A lot of FL residents are snow-birds, they live in Pittsburgh or Cleveland in the summer, where they have one cardiologist, and then winter in FL where they have another one. The two docs try to make sure the patient has their "annual" stress test (I guess insurance companies pay for 1 per year) at their practice.

    So I'm wondering how widespread folks think this is. Out of the ordinary? Part of the natural order of for-profit medicine? Not a big deal? A huge deal?
  2. bigredfutbol

    bigredfutbol Moderator
    Staff Member

    Sep 5, 2000
    Woodbridge, VA
    DC United
    Nat'l Team:
    United States
    The field I'm most familiar with, both through personal experience and through my wife who has made it her career, is gerontology. She knows quite a bit about broader issues concerning Medicare, long-term care, and other areas of health care.

    I'd say this is par for the course, sadly.
  3. flowergirl

    flowergirl Member+

    Aug 11, 2004
    panama city, FL
    Columbus Crew
    Nat'l Team:
    United States
    sadly, true across the board in most specialties. they will try to get away with billing as much as they possibly can. and it won't change until the whole system gets an overhaul and pay for individual services is gone.
  4. Chris M.

    Chris M. Member+

    Jan 18, 2002
    Yea, I once had a couple of tests. Then, the cardiologist said, "I feel 95% sure that everything is fine, but we don't want to take a chance with that 5%." So then he did an angiogram. I was pissed off. If the results of the early tests are going to show nothing and you are going to do the third anyway, why not just do the angiogram first? I did feel like I was getting gauged.
  5. CHICO13

    CHICO13 Moderator
    Staff Member

    Oct 4, 2001
    SECTION 135
    The Strongest La Paz
    Nat'l Team:
    I had open heart surgery in 2006. I met with my surgeon 2 months before and then one week before. For all I know hemay not even have performed the surgery because I never saw him again One of his partners came into check on me twice before I was released. Then I followed up with my own cardiologist. Something about him being way to busy. Nice, huh?
  6. JohnR

    JohnR Member+

    Jun 23, 2000
    Chicago, IL
    I'm sure medical ethics are awful. First, the drug and device industries bribe doctors to use their products. Second, the industry's pricing sets up huge conflicts.

    The Wall Street Journal had a sad but hilarious story about a con man Miami Beach doctor who hired Playboy model types to give some sort of massage therapy thing that is reimbursed by Medicare. The therapy was so easy to deliver that the girls could do it, Medicare paid enough so that the doc could pay the beauties and still take a very nice cut, so he just prescribed the therapy to anybody who came by. And a lot of people came by, because who doesn't want a free (after Medicare pays) massage from a Playboy model?

    That's an extreme case but the basic point stands. Very very often, doctors stand to make more money if they do something that the patient does not need, than if they address the patient's true need. And no group of people, not doctors, not anybody else, will be able to consistently resist such economic temptation.
  7. Demosthenes

    Demosthenes Member+

    May 12, 2003
    Berkeley, CA
    Nat'l Team:
    United States
    I had a doctor that insisted on writing "dispense as written" on scrips, claiming that you don't know what you're getting with the generic drug, which was complete BS. I can't imagine what kind of legal kickback she could have been getting from the drug company, but I stopped going to her rather than keep paying for brand name drugs.

    In another case, I went to a local walk-in clinic a few years ago. I had a chronic cough and I wanted to get it checked out. Before the doc would even see me, they administered an ECG. This is their standard procedure! Obviously they have a lot of lower income patients and they can charge Medicaid for these unnecessary tests.
  8. JohnR

    JohnR Member+

    Jun 23, 2000
    Chicago, IL
    I was in Spain and had a problem with my ear. I went to a Catholic hospital. They said they could do an expensive treatment, or a cheaper treatment that would alleviate things temporarily, so that I could finish my vacation. I chose the cheaper treatment. My bill was $30. ;) Yes, $30. For a visit to the emergency room, 5 - 10 minutes consultation with a doctor, and then a short treatment from a nurse.

    I'm willing to bet that for 99% of the people, in 99% of the cases, the medical care in Spain is equal or better than in the U.S., at a fraction of the cost. For transplants and very rare diseases, probably not. Seems like a very stupid tradeoff to me. But damn there are so many Americans who love our system and wouldn't change it for the world. They need to get out more.
  9. Nettle

    Nettle New Member

    Aug 15, 2010
    Yeah, seems to be the case with medical abuse, at least from what I've read from this cardiologist's blog.

    Dr. Davis will sometimes write about the inside view of cardiology - from other doctors actions, to drugs that work poorly, unnecessary tests, unneeded radiation exposure, etc.

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