| joyceb 2004-10-07, 7:08 am |
| > I do not believe that many comanaging physicians provide detailed
> information regarding who gets paid what. There is a general
> assumption that the patient understands a portion of the global fee
> goes to the doctors providing the care, but I am doubtful the exact
> amounts are discussed with the patient.
> There is generally a trust in physicians that they will do what
> is best for the patient, not necessarily what is best for their
> pocketbook. For the most part, IMO that trust is earned and
> appropriate. There are, however, a few doctors who push the limits of
> propriety.
> These are the issues that a patient needs to raise. That is, of
> course, if the patient is interested. For all the concern we state
> about these financial arrangements, I find that the attitude of the
> public is that they don't care who gets what or who does what as long
> as they get what they want. It is only if there is a poor outcome or
> poor service that the issue of monetary distribution becomes important
> to the patient. That may be naive, but it does seem to be the way the
> public perceives the situation.
I'm trying my best to reconcile the three paragraphs quoted above; so
far, I have not been successful.
In the first, you seem to be stating that most patients don't know the
details of the financial arrangements between their optometrist and
surgeon. In the second, you seem to be stating that physicians enjoy
a unique (and earned) level of trust from patients. In the third, you
seem to be saying, "It is up to the patients to connect the dots, and
most don't really care anyway."
If a doctor is trusted, then by definition, a patient will not subject
that doctor to the same healthy skepticism he gives a salesman. If a
patient trusts his doctor's motives, then by definition, he will not
question them. And even if the level of trust is less than 100%, if
the financial relationships are not understood, there can be no
reasonable expectation that the patient will, in fact, connect the
dots, or care enough to try.
Glenn, would you please clarify your position by answering the
following question?
Do you believe that the professional judgment of the average doctor
(hard-working, honest, caring, etc.) is 100% immune to financial
considerations?
If your answer is "yes," please tell me why you believe this is so.
If your answer is "no," please tell me why patients' trust in doctors
is "earned and appropriate".
Thank you for your time.
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