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Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor
To the Editor: Even though many physicians
have not actually sworn the Hippocratic oath, the concept "first do no harm"
is still impressed on all those who study medicine, or so I thought. Thus,
I read the article by Dr Wynia and colleagues1
with much sadness on behalf of our profession.
Stated bluntly, the article reveals widespread lying, cheating, and
stealing in the name of patient care. It reveals the decline of a noble profession
in which physicians were once pillars of respectability in their communities.
The behaviors described in the article also may augment physicians' income.
While patient advocacy is noble and in keeping with the high ideals of our
profession, absconding with illicitly gained professional fees is not.
Is it any wonder that third-party payers require so much documentation
of medical necessity? They, and the patients and employers whose insurance
money is being spent, must be protected against false claims and payment for
services excluded by a patient's contract.
If physicians are truly concerned about patients, they can lobby for
broader insurance coverage for benefits that are currently not covered, knowing
that such care will ultimately raise premiums. However, then at least physicians
will not become hawkers of "tainted" services. We should work with patients,
employers, the insurance industry, and insurance regulators to ensure that
covert issues of insurance coverage are uncovered. We must realize, however,
that no insurer can be all things to all patients or physicians.
Professional acts of mercy can be performed with fairness and justice
toward each concerned party. Wynia et al reveal professional ignobility found
only in dark and shadowy corners and expressed through the deceiving contrivances
of ambiguous words meant to unfairly disarm the fiduciary agents of patients.
This short-term gain is our profession's long-term loss. Together, we must
advocate not only for patients but also for our profession.
Barham FL. Should Physicians Manipulate Reimbursement Rules to Benefit Patients? JAMA. 2000;284(11):1382–1383. doi:10.1001/jama.284.11.1378
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