Difficult patients - difficult doctors

Forget about the law for a moment, and suspend your disbelief: Are patients entitled to reject a particular attending physician because of the doctor's color of her skin, her religious beliefs or for no reason at all? This is the subject of a debate currently ongoing on an international listserv of bioethicists. I must say, I have never given much thought to this issue. I mean, it is straightforward that doctors could not reject to attend to patients for any of those reasons - there are as few conscientious objection rationales for particular procedures, but really even they don't make much sense to my mind and should be rejected. The point is that doctors are professionals and need to act as professionals. Non-professional reasons (aka skin-color, party membership and other such matters) don't count as acceptable rationales for refusing to attend to particular patients.

However, what about patients. There's all sorts of people out there, and some are morons. So, what if a patient doesn't want to be seen by a particular doctor for moronic reasons, say the doctor's membership in a particular church, the doctor's skin color and other non-professional matters. Some of my colleagues, certainly colleagues I hold in high esteem, argue that motives that are unacceptable (eg racist motives) should be ignored and the patient request declined. My gut feeling was initially that that probably is the right approach. Why give in to blatantly racist attitudes for instance. Stuff em I thought.

Well, here's the counter argument: some other bioethicists claim (they did not provide evidence, but let's assume their claim is correct) there is evidence that having to deal with attending doctors that patients can't cope with (for whatever reasons) has a negative impact on health outcomes, and those health outcomes should be our primary concern. That argument persuaded me - that is until I discover that there's no evidence to support the empirical claim I have just outlined.

Tricky one though, hu? What do you think?

US Health Care Debate

I'm sure it's tempting to go on and on and on about the US health care debate, but really, the less said the better. So, the Democrats (a party nearly as sad and as spineless as the Liberals in Canada) barely managed to get what they consider a reform package thru the Congress where they have a massive majority. A lot more people will be able to access health care, that's about the only good news. The bad news is found all over the place. The skyrocketing share prices of major insurance companies tell you who the real winner of this exercise is: shareholders of insurance companies. There's no public option, so the milking of individual patients by insurance companies will continue. Wow, amazing reform this is! Then there have been those right-wingers (teabag, sandbag and otherwise) that went on and on and on about a government takeover of health care. I only wish there had been a government take-over. Sadly there wasn't. All this silly hand-waving about losing lack of control over one's health care was just mind boggling. I would prefer a government controlled health care system over one controlled by for-profits at any time. Why should control over my access to a given surgical procedure by an employee of a for-profit insurance company give me any more choice than if the same was undertaken by a doctor in a public health care system? Well, what can I say, having lived in countries with public health care (UK, Australia, Canada), government health care is preferable to for-profit health care at any time. It is that simple. It's cheaper and more efficient in terms of bang for your buck. You wouldn't expect US Americans that rely on Fox agitprop to realize that. Well, and Mr Obama, much like the Canadian Liberal's Ignatieff, should probably have gone into academia as opposed to politics. I wouldn't call his last minute scramble a 'fight' (of the political kind) for health care reform. More of a sell-out in terms of progressive politics.