A Philosopher's Blog

A Patient’s Right to Know

Posted in Ethics, Medicine/Health, Philosophy by Michael LaBossiere on April 29, 2016

English: Livingston, TX, 9/25/05 -- A doctor t...

All professions have their problem members and the field of medicine is no exception. Fortunately, the percentage of bad doctor is rather low—but this small percentage can do considerable harm. After all, when your professor is incompetent, you might not learn as much as you should. If your doctor is incompetent, she could kill you.

The May, 2016 issue of Consumer Reports includes a detailed article by Rachel Rabkin Peachman covering the subject of bad doctors and the difficulty patients face in learning whether a physician is a good doctor or a disaster.

Based on the research in the article, there are three main problems. The first is that there are bad doctors. The article presents numerous examples to add color to the dry statistics and this include such tales of terror as doctors molesting patients, doctors removing healthy body parts, and patient deaths due to negligence, impairment or incompetence. These are obvious all moral and professional failings on part of the doctors and they should clearly not be engaged in such misdeeds.

The second is that, according to Peachman, the disciplinary actions taken by the profession tend to be rather less than ideal. While doctors should enjoy the protection of a due process, the hurdles are, perhaps, too high. There is also the problem that the responses to the misdeeds are often very mild. For example, a doctor whose negligence has resulted in the death of patients can be allowed to keep practicing with only minor limitations. As another example, a doctor who has engaged in sexual misconduct might continue practicing after a class or two on ethics and with the requirement that someone else be present when he is seeing patients. In addition to the practical concerns about this, there is also the moral concern that the disciplinary boards are failing to protect patients.

One possible argument against harsher punishments is that there is a shortage of doctors and taking a doctor out of practice would have worse consequences than allowing a bad doctor to keep practicing. This would be the basis for a utilitarian argument for continuing mild punishments. Crudely put, it is better to have a doctor who might kill a patient or two than no doctor at all.

This argument does have some appeal. However, there is the factual question of whether or not the mild punishments do more good than harm. If they do, then one would need to accept that this approach is morally tolerable. If not, then the argument would fail. There is also the response that consequences are not what matters—people should be reprimanded based on their misdeeds and not based on some calculation of utility. This also has some intuitive appeal.

It could also be argued that it should be left to patients to judge if they want to take the risk. If a doctor is known for sexual misdeeds with female patients but is fine with male patients, then a man who has few or no other options might decide that the doctor is his best choice. This leads to the third problem.

The third problem is that it is very difficult for patients to learn about bad doctors. While there is a National Practitioner Data Bank (NPDB), it is off limits to patients and is limited to people in law enforcement, hospital administration, insurance and a few other groups.

The main argument advanced against allowing public access to the NPDB is based on the premise that it contains inaccurate information which could be harmful to innocent doctors. Interestingly enough, this makes it similar to the credit report data—it is notorious for containing harmful inaccuracies that can plague people.

While the possibility of incorrect data is a matter of concern, that premise best supports the conclusion that the NPDB should be reviewed regularly to ensure that the information is accurate. While perfect accuracy is not possible, it would seem to be well within the realm of possibility for the information to meet a reasonable standard of accuracy. This could be aided by providing robust tools for doctors to inform those running the NPDB of errors and to inform doctors about the content of their files. As such, the error argument is easily defeated.

Patients do have some access to data about doctors, but there are many barriers in place. In some cases, there is a financial cost to access data. In almost all cases, the patient will need to grind through lengthy documents and penetrate the code of legalize. There is also the fact that this data is often incomplete and inaccurate.  While it could be argued that a responsible patient would expend the resources needed to research a doctor, this seems to be an unreasonable request—a patient should not need to do all this just to know that the doctor is competent. A reason for this is that a patient might be in rough shape and expecting her to engage in all this work would seem unfair. There is also the fact that one legitimate role of the state is to protect citizens from harm and having a clear means of identifying bad doctors would seem to fall within this.

Given the above, it seems reasonable to accept that a patient has the right to know about her doctor’s competence and should have an easy means of acquiring accurate information. This enables a patient to make an informed choice about her physician without facing an undue burden. This will also help the profession—good doctors will attract more patients and bad doctors will have a greater incentive to improve their practice.

 

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One Response

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  1. nailheadtom said, on April 29, 2016 at 8:48 pm

    “good doctors will attract more patients and bad doctors will have a greater incentive to improve their practice.”

    How can the patient actually determine if the doctor that treats him is good or bad? Does his survival mean
    the doctor is a good one? If he dies, is the doctor necessarily inept? In most cases it’s likely that the impression the doctor makes on a patient is most important. If the patient likes the doctor he’s likely to have a positive opinion of him.

    The history of the medical profession isn’t an especially pretty one: http://nailheadtom.blogspot.com/2010/02/death.html

    Moreover, in the current era, medical practice has come to embrace technology as never before. Electronics and computers now gather information about the patient’s condition, analyze it, and recommend treatments. Doctors, well-educated and highly paid professionals, are no longer required to exercise their intuitive talents. They have become technicians or at the most leaders of groups of technicians. They are immensely overpaid.


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