Jewish World Review May 7, 2004 /16 Iyar 5764

Drs. Michael A. Glueck & Robert J. Cihak

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Consumer Reports


Fear in the Medical Garden of Eden


http://www.NewsAndOpinion.com | Some years ago - a friend tells us - he was attending a large, fund-raising luncheon: 800 people in the ballroom of a downtown hotel. Midway through the guest speaker's unremarkable spiel (a presidential candidate at the time) a woman in the audience started screaming, clearly in more pain than the droning warranted. Two things happened. Several men, obviously physicians, started moving toward the stricken woman, each eyeing the others and doing his best to get to her second. And the speaker, somewhat shaken, said, "Would someone please call 911." Several hundred people whipped out their cells.


Then two other things happened. It turned out that the woman, a prominent local attorney, had been the victim of an accidental hot coffee pot spill and needed no medical care. And all those people calling 911 crashed the system.


The lady and the emergency line both recovered. What concerns us here is the reticence of the physicians to attend to a person in distress, for fear of subsequent legal action, should their ministrations prove improper or unavailing, or even proper and helpful. For those doctors were showing symptoms of the greatest unrecognized crisis in modern medicine.


Call it "Refusal to Treat", the deliberate withholding of care.


Today, medicine is everywhere. Health care accounts for one-seventh of the Gross Domestic Product, a share that will grow as the population ages. And yet, more and more, "Refusal to Treat" influences the practice of medicine. Your Medicine Men have written about various aspects of the problem. But, to our knowledge, no one until now has (as they say at the 9/11 Commission) "connected the dots."


Herewith a sampler of "Refusals to Treat".


Refusal to Treat for personal moral and ethical reasons. Abortion and euthanasia provide the most obvious examples here. But there are others, ranging from purely cosmetic procedures ("No, madam, you don't need your toes tapered so you can wear those ridiculous overpriced shoes") to quiet unwillingness to comply with various public health mandates, such as excessive and unnecessary vaccination.


Going on strike, usually in order to protest exorbitant insurance premiums. This happened in 2002 and 2003 in the South, East, Midwest, and in the high-profile Las Vegas emergency room shutdowns. The public was shocked and chagrined. The rates remained high.

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Moving out of states where premiums are unbearable or courts particularly vindictive.


Getting out of the business partly or entirely. More and more physicians are taking early retirement, fed up with the hassles of dealing with insurance companies, HMOs, and the government. For the patient it's also getting harder and harder to find an obstetrician, or a pain management specialist.


Opting out of the Medicare system, i.e., refusing to treat Medicare patients because of over-regulation, administrative hassles, and restrictions upon practice once you take a dime of Uncle Sammy's money. Sam's regulations run in the hundreds of thousands of pages!


Fear of criminal prosecution. Today, billing the government means trying to unravel an incomprehensible and often contradictory set of regulations. Even honest mistakes of no great cash value now invite criminal prosecution, or at the very least, years of special attention from the auditors. Pain management specialists have also learned to expect the DEA's knock on the door at any moment, should some bureaucrat or enforcer not like the way they practice, or should their legally prescribed medications end up in the wrong hands.


Two other Refusals to treat stem from the Mother Nature of Things.


Today, much of the health care business seems a bizarre caricature of capitalism, in which the only way to make money is to withhold the product. When people pay a set fee each month for potentially unlimited services, providers quickly reach the point at which they have to start saying No, usually defined as some sort of new medical "best practice." For example, many shocked women in the senior ranks write us that their physicians will not authorize a repeat Pap smear for three years -- since their current smear is negative.


And finally, state medicine. As America moves toward "single payer" socialized medicine, we will discover that single payer really means "single buyer." And when there's only one buyer who controls the market, you get what they're willing to pay for. And if it's illegal to go outside the state system - once again, the government will be engaged in the business of creating criminals where no criminality exists.


And so it is in the aggregate: all those little refusals starting to add up to one big Refusal. As Lucy once put it in the 1967 Off- Broadway Theatre 80 play, "You're a Good Man, Charlie Brown," - look at my fingers. Individually they may not count for much. Together they become a formidable weapon. In this case one of evil.


"Refusal to Treat" . . . the fist of fear and frugality that's coming stat.

Editor's Note: Michael Arnold Glueck wrote this week's column.




Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute Senior Fellow and a past president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here.

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