Kathryn Hinsch, founder of the Women's Bioethics Project, was quoted on CNN Health, regarding ethical issues in cosmetic surgery and patient-doctor relationships:
"Part of the fundamental trust between a patient and doctor is the idea that the doctor has the patient's best interest at heart, and that there is no financial incentive for the doctor to perform any procedure," Hinsch says. "When doctors start adding cosmetic procedures, which they're adding because they're big moneymakers, there's a corruption of that basic trust."
The article goes on to explore how physicians sidestep this ethical quagmire by never directly hawking their fat-blasting, wrinkle-smoothing, and hair-removal services, but that even a stack of brochures in the waiting room, Hinsch insists, sends the message to patients that looking younger is a matter of good health. To read the complete article, click here.
Kudos to Kathryn for the recognition and speaking up on the ethical issues!
Showing posts with label doctor/patient relationship. Show all posts
Showing posts with label doctor/patient relationship. Show all posts
Wednesday, December 02, 2009
Monday, October 27, 2008
Medical Ethics & Human Rights: Impact on the Doctor-Patient Relationship
Event Announcement
The Appignani Bioethics Center and NGO Health Committee are co-sponsoring a panel discussion on human rights and their impact on doctor-patient relationship.
Date & Place: Wednesday, October.29, 2008, 1:00 PM-3:00 PM, 777 UN PLAZA, 10th Floor, 10th floor - Conference Room, NY 10017A 15 minutes documentary film will be presented entitled "Children of the Decree" by Romanian filmmaker Florin Lepan. In 2004 the film was selected for screening in NYC by the Margaret Mead Film & Video Festival. This documentary analyzes Romania's quest during Ceausescu's dictatorship to increase their population by over fifty percent in a single decade through imposing a ban on abortion from 1966 till 1989. It was a unique experiment in human reproduction infringing upon women's rights:
Monday, February 25, 2008
Patient Responsibility for Medical Outcomes
Universal health care in the U.S. would be a step in the right direction toward solving some of our many problems in the area of costs and delivery. One of the numerous pressures on costs are malpractice and negligence lawsuits. Physicians pay astronomical liability premiums. A significant portion of hospitals' budgets is spent on in-house legal departments. All health care providers and facilities are at risk in our litigation-happy society.
The ideal doctor-patient relationship is a partnership. Ultimately, both parties need to agree to participate in the care rendered. Patients should hold up their end of the bargain and refrain from suing their doctors at the drop of a syringe. Tort reform regarding medical practice would provide significant relief. For example, an ombudsman-like system of board review could be implemented. If a physician's actions were deemed to have met the standards of care in her specialty, a potential lawsuit against her could not go forward. Such a system could address both malpractice and negligence.
Cost savings would be enormous and would impact bottom lines across a broad spectrum of agents and agencies. Federal, state, and local resources would be freed-up from costly courtroom expenditures on wasteful medical litigations.
In a groundbreaking example of high-level support for such proposals, the U.S. Supreme Court ruled on 2-20-08 that "makers of medical devices like implantable defibrillators or breast implants are immune from liability for personal injuries as long as the FDA approved the device before it was marketed".
A case involving similar preemption for FDA-approved drugs will be heard by the Court in its next term.
This is a welcome trend, both economically and socially. The concept of personal responsibility has been battered and broken-down in the U.S. for many decades. "It's not my fault", people claim. "Twinkie's made me do it." Yes, a doctor prescribed a drug. Yes, a medical device was used. Yes, that drug or device had a manufacturer. But the patient agreed to treatment. Medicine is an art. There are frequent unexpected outcomes. Of course, we want to uphold best practices. Given best practices, lawsuits in medicine are inappropriate and need to be reined-in.
Manufacturers of defective products will still be liable. However, quality control is not a 100% guarantee. One malfunctioning device in an otherwise successfully deployed lot should not be grounds for a multimillion dollar lawsuit. Risks need to be shared. Full disclosure and informed consent are the tools to make these lawsuits go away.
Likewise for drugs. It seems obvious that the bottom line for global pharmaceutical companies is stock price and shareholder value rather than patient welfare. It may be that ultimately, in many cases, reliance on pharmaceuticals is misguided. In Global Pharmaceuticals: Ethics, Markets, Practices, Adriana Petryna and Arthur Kleinman describe the American "fetishization of pharmaceuticals" and the "pharmaceuticalization of certain disorders".
On 2-15-08 the FDA proposed new guidelines that "would allow drug and device makers to provide doctors with copies of medical journal articles" that discuss off-label product uses. The rules also say "drug companies do not have to promise to adequately test the unapproved use discussed in the article".
These proposed guidelines represent a radical sea change in policy. On the surface, they seem to pander to the desires of big pharma. This seems very problematic. On the other hand, FDA approval is not a guarantee of development of significant side-effects, as with the COX-2 inhibitors such as Vioxx.
The reality is that most drugs are not magic bullets. The playing field has shifted. Patients need to be protected, and that protection is best offered by regulation and information. But our regulatory system seems badly broken, and off-label usage may provide great benefit. Or it may not.
Medical risks need to be shared. Patients are not merely consumers. They are obligated to do their best to make informed choices. On the other hand, physicians need to clean-up their questionable relationships with drug manufacturers and drug representatives.
We want a health care system based on best practices, not based on most money.
The ideal doctor-patient relationship is a partnership. Ultimately, both parties need to agree to participate in the care rendered. Patients should hold up their end of the bargain and refrain from suing their doctors at the drop of a syringe. Tort reform regarding medical practice would provide significant relief. For example, an ombudsman-like system of board review could be implemented. If a physician's actions were deemed to have met the standards of care in her specialty, a potential lawsuit against her could not go forward. Such a system could address both malpractice and negligence.
Cost savings would be enormous and would impact bottom lines across a broad spectrum of agents and agencies. Federal, state, and local resources would be freed-up from costly courtroom expenditures on wasteful medical litigations.
In a groundbreaking example of high-level support for such proposals, the U.S. Supreme Court ruled on 2-20-08 that "makers of medical devices like implantable defibrillators or breast implants are immune from liability for personal injuries as long as the FDA approved the device before it was marketed".
A case involving similar preemption for FDA-approved drugs will be heard by the Court in its next term.
This is a welcome trend, both economically and socially. The concept of personal responsibility has been battered and broken-down in the U.S. for many decades. "It's not my fault", people claim. "Twinkie's made me do it." Yes, a doctor prescribed a drug. Yes, a medical device was used. Yes, that drug or device had a manufacturer. But the patient agreed to treatment. Medicine is an art. There are frequent unexpected outcomes. Of course, we want to uphold best practices. Given best practices, lawsuits in medicine are inappropriate and need to be reined-in.
Manufacturers of defective products will still be liable. However, quality control is not a 100% guarantee. One malfunctioning device in an otherwise successfully deployed lot should not be grounds for a multimillion dollar lawsuit. Risks need to be shared. Full disclosure and informed consent are the tools to make these lawsuits go away.
Likewise for drugs. It seems obvious that the bottom line for global pharmaceutical companies is stock price and shareholder value rather than patient welfare. It may be that ultimately, in many cases, reliance on pharmaceuticals is misguided. In Global Pharmaceuticals: Ethics, Markets, Practices, Adriana Petryna and Arthur Kleinman describe the American "fetishization of pharmaceuticals" and the "pharmaceuticalization of certain disorders".
On 2-15-08 the FDA proposed new guidelines that "would allow drug and device makers to provide doctors with copies of medical journal articles" that discuss off-label product uses. The rules also say "drug companies do not have to promise to adequately test the unapproved use discussed in the article".
These proposed guidelines represent a radical sea change in policy. On the surface, they seem to pander to the desires of big pharma. This seems very problematic. On the other hand, FDA approval is not a guarantee of development of significant side-effects, as with the COX-2 inhibitors such as Vioxx.
The reality is that most drugs are not magic bullets. The playing field has shifted. Patients need to be protected, and that protection is best offered by regulation and information. But our regulatory system seems badly broken, and off-label usage may provide great benefit. Or it may not.
Medical risks need to be shared. Patients are not merely consumers. They are obligated to do their best to make informed choices. On the other hand, physicians need to clean-up their questionable relationships with drug manufacturers and drug representatives.
We want a health care system based on best practices, not based on most money.
Friday, January 11, 2008
Help your doc help you....
The illustrious Dr. Jerome Groopman (who was recently interviewed on NPR) recently published a new book, How Doctors Think. It's an expanded version of an article he wrote for The New Yorker.This is a more engaging read than one might think at first blush, in part because of Groopman's liberal use of stories and anecdotes. These illustrate the information he really wants to share with us: the facts that (a) doctors are not perfect, (b) they make predictable errors in diagnosis, often due to cognitive or emotional biases, and (c) we--the general public--can help doctors avoid these pitfalls if we know what they are. By asking, for example, "Is there anything else it could be?" or "Is it possible that I have more than one problem?" we can help the doctor consider options she may have overlooked.
So why is this relevant to you, the WBP reader? Well, two reasons leap to mind. The first is that women continue to play the role of healthcare decision maker for their families, and so we're often in the best position to ask the right question at the right moment. The second is that my own mom, and many other moms of my acquaintance, have shared their stories of "knowing something was wrong" with a loved one, even when the doctors weren't able to find anything at first. Though Groopman doesn't seem to think of it this way, a piece of advice that fits right in with the rest of his argument is "Trust your own intuition--at least far enough to ask the doctor that one more question."
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