| Glenn - USAEyes.org 2004-10-07, 7:11 pm |
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>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.
Most don't know the exact details, but any reasonably intelligent
person knows that the people providing services are being paid.
> In the second, you seem to be stating that physicians enjoy
>a unique (and earned) level of trust from patients.
Yes, and that trust extends to all elements of the physican-patient
relationship...including financial. If you think your doctor is going
to steal your wallet, you don't "trust" that doctor even if the
medical advice is brilliant.
> 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."
All the financial dots are clearly visible and solidly in place, even
if the exact size of each dot is not defined. Some people are
concerned, but most are not.
>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.
Your analysis requires the doctor to be physician OR salesman. In
reality, most are both. The optometrist recommends a certain brand of
contacts. Is that because they are better for the patient or because
they have a higher profit margin? The optometrist recommends
anti-scratch coating. Is this to extend the life of the spectacles or
because it ads a few dollars to the bottom line? The OD recommends a
certain surgeon with whom s/he comanages. Does the OD comanage with
this doctor because s/he is the best in the area or because this
particular doctor splits the pot more in favor of the OD?.
>And even if the level of trust is less than 100%
I may be a cynic, but I don't believe anyone trusts anyone 100% when
there is money involved.
>, 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.
That a financial relationship exists is obvious to any reasonable
person. If that financial relationship is a concern to the patient
(or if they read out 50 Tough Questions For Your Doctor), the
questions will be asked.
>Glenn, would you please clarify your position by answering the
>following question?
My "position" is that comanagement can be appropriate, even
advantageous, and that the patient should evaluate the comanaging
doctor in a similar fashion as the surgeon, including financial
arrangements.
http://www.usaeyes.org/faq/subjects/comanagement.htm
>Do you believe that the professional judgment of the average doctor
>(hard-working, honest, caring, etc.) is 100% immune to financial
>considerations?
I don't think anyone is "immune" to financial considerations, however
the amount that a person is influenced can vary greatly.
I don't think the Dali Lama is going to make a deal with the Devil for
a few Shekels, but he is the spiritual leader of a vast organization
that relies on financial support to exist. He may love to speak to
the masses, but somebody has to rent the stadium and pay for his
airfare and hotel room.
In this particular instance the real financial controversy is not if
the OD gets paid (of course the OD gets paid), but if the OD is paid
an amount greater than what is reasonable for his or her services
and/or the financial arrangements are influencing his or her
decisions. This is why we suggest the patient write separate checks.
The patient will know who is being paid what, and has the opportunity
to determine, based upon his or her own unique concerns and values, if
the reimbursement is appropriate.
Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
Email to glenn dot hagele at usaeyes dot org
http://www.USAEyes.org
http://www.ComplicatedEyes.org
I am not a doctor.
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