The matter under discussion is confidentiality and its issues. It includes to what extent the physicians should share a patients results with his relatives and also how physicians use deception in order to get insurance companies to pay for their patients. We will also be discussing the factors that drive the physicians into doing this.
The American Medical Association has recently highlighted the keeping the results of a patient confidential unless under serious circumstances. Suppose a patient is detected with Huntington’s disease, which is hereditary, and she asks the physician to not tell her child. The physician now has two conflicting obligations. On one hand he must respect the patient’s request while on the other hand; he must inform her relative (daughter) so that she can plan her future accordingly. The physician must come up with a solution that will fulfill both his obligations to some extent. This involves discussion with the patient and making her realize how importance it is for her daughter to know about her disease and giving it time. If the mother agrees on telling her daughter, the daughter must be told in a way that would cause least level of distress and harm on the other hand, if the mother does not agree, her wishes must be fulfilled unless under extreme circumstances. However, to avoid all this, a physician must decide on a policy with the patient before testing, which will decide with whom the results will the shared and under what circumstances, the confidentiality may be broken.
A study by G Caleb Alexander et al. was carried out with the aim to find out the general public’s attitude regarding deception by physicians in order to get expensive treatments for their patients. The case study involved 700 participants who were asked to complete a survey. The survey included a scenario where a patient’s insurance company was not willing to pay for his treatment and a few options were laid down in front of them. Either the physician would accept the insurance company’s decision, appeal to the insurance company or misinterpret the facts to get the support for treatment of the patient. The results showed that 26% of the respondents were in favor of deception while 70% supported appealing and 4% thought that accepting the decision was the best option. The results showed that the public somewhat approves of this act. However, these results were affected by whether or not the physicians had time for the appeal process.
A similar case study was carried out which involved 1617 physicians as participants. They were given a scenario and the same options that were given to them in the case study above. The results showed that 77% of the physicians would appeal, 12% would accept and 4% would deceive. However these decisions depended on the chances of having a successful appeal, time duration of appeal process and the condition of the patient. As the complications and time of appeal process increased and the likelihood of a successful process decrease, the physicians were more willing to misinterpret the data. The physician may also deceive because of his loyalty towards his patients or on the patient’s requests. Despite all these factors, this practice is considered unethical by organization like American Medical Association etc.
After discussing a few issues of confidentiality, it can be concluded that in the Huntington’s case, a solution is necessary that will ensure the patient’s requests and also the health of her daughter. Also there are conditions under which deception could be used by physicians. But physicians must make sure that an expensive treatment should not be used if the same patient can be treated by using cheaper methods. Also if it were me, I would also deceive if doing so would save my patient’s life.