Ethical Dilemma: Doctors as Patients
I got a phone call from a doctor I've covered for from time to time. He had a favor to ask me: would I write a referral for an MRI for him?
Actually, he had his office staff call my staff. I asked to speak to him directly.
It turns out the MRI was a perfectly appropriate follow-up for a questionable CT finding. Usually he writes all his own referrals, but for some reason in this case, the facility was refusing to accept the referral from his office, even though the insurance company had no objections. As it happened, his insurance was a capitated plan. He'd have to switch to my office as a patient; I'd receive capitation payments for him, but then again all his referrals would count towards my utilization figures.
I thought about what I should do.
It's a well-documented fact that many doctors -- especially those in primary care -- do not have a personal physician. They do what this guy does: take care of things themselves. It's also pretty clear that this is not a good idea.
So I offered as tactfully as I could to see him in my office, mainly to have a chart on him so we could document results of tests as well as referrals (in case the HMO came a-calling), but also to serve as his personal physician.
He went on for awhile in such a way as to imply that what he was asking wasn't such a big deal and that he thought I was making more of a fuss over it than I should. He'd once needed an MRI of his knee, and a mutual orthopedist friend had written the script without a second thought. He ended the conversation by saying that he'd call around and see if he could find someone else willing to help him out, and would get back to me.
I found myself reflecting on the interaction.
What if the roles were reversed? Certainly I've written myself orders for routine screening tests. I even have a "chart" for myself in my office to keep track of labs and immunizations and other things. I occasionally go see a doctor -- usually a specialist -- for specific acute problems, but I must confess that I do not have a personal physician. However if I found myself in the position of needing a primary physician for administrative purposes, and if that physician were to gently indicate that he (and I, for that matter) wouldn't do what I was asking for a patient without a visit, I would probably sigh, admit to myself that he was right, and go see him as an actual patient.
It bothered me that this guy didn't seem to get it. It's just paperwork for a stupid insurance company. Can't I do a favor for a colleague?
Well let's see. I frequently get calls from neighbors and friends looking for "favors." Sometimes they don't have a doctor; other times they just don't want to bother theirs. (I usually manage to ignore the insult implied by the fact that they're willing to bother me.) I've learned to say no to these requests. Without a doctor-patient relationship -- which includes a visit, an exam and a chart -- I won't sign, order or prescribe anything. It's bad medicine, and -- oh yeah! -- illegal.
So why is it any different when it's a doctor/colleague?
I decided that it wasn't.
Tell me if -- and how -- I'm wrong.