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Tag Archives: Healthcare

Patient recovery or monetary revenue?

01 Wednesday Apr 2015

Posted by Uta Mittelstadt in Food for thought

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Allopathy, Conventional medicine, Healthcare, informed patient, monetary revenue, recovery, respect

It is not seldom that when hearing patient stories that I am told about their previous experiences within the realm of conventional medicine. Quite shockingly, these explanations frequently disclose a therapeutic relationship that makes me shudder. It seems that doctors and health care providers are increasingly focusing, not, on the aim of providing speedy patient recovery, but are seeking opportunities for the application of costly treatments and medicinal regimens. This is a somewhat worrisome development in orthodox healthcare. Where are we at if patient illness is viewed as a means of increasing monetary revenue, rather than a state of suffering that needs to be relieved? What are the consequences of such comportment? Must we as patients fear to receive unnecessary therapeutic procedures to create an income for a hospital or clinic? Are we guinea-pigs for regimens that ensure the greatest monetary support for an individual practice or an institution?

The following excerpts of patients experiential reports of the comportment of medical staff towards them in their care, have unveiled some disturbing conduct that clearly has not the patients well-being prioritized. These cases painfully highlight that something is not right in the healthcare sector.

1. During an incident at a hospital, an entire team surrounding a surgeon exerted immense pressure on the patient to immediately undergo an emergency surgery. When demanded an explanation of the situation at hand, its urgency and insistence, the surgeon denied the details requiring such emergency handling. He responded with the words: “No! I don´t have to! I will not tell you because you will not understand!”. Somewhat baffled at this exclamation, the interrogation was continued. Yet, the response always remained the same: “I will not, and must not, because you will not understand!”.

Following such irritation, the patient asked to view test results and exam data, but was denied these on the same account that they simply would not be understood. Only long discourse, arguing and true battling for access to exam images and laboratory print-outs, finally gave access to these, albeit only under severe protest. During this time, the heating in the room, where the patient was resting, was increased. The patient and his family began sweating and were increasingly becoming very uncomfortable. When asking for the temperature to be turned down, this request was briskly and quite harshly denied. It was even warned to keep all doors closed and to not permit ventilation. Nobody did quite understand this. A short while later a nurse came to take the patients temperature. This was now elevated by about half a degree as opposed to earlier measurements. Now, once again the entire team of doctor and medical personnel pressurized the patient with the insistence that he now was in an inflammatory, an emergency state (due to the elevated body temperature) and would now have to undergo surgery imminently. Ehh? What? What bogus behaviour from persons that stand in the service of patients and their health care! They turned up the heating to increase the body temperature such that this would suggest an inflammation, so that they would get their way of conducting a surgical intervention??

The situation was resolved by the family’s decision to leave this hospital immediately. The surgeon pretended to be in utter shock and questioned how one could possibly dare to take such an irresponsible step. Once the decision was made, the entire team, doctor, nurses and carers, stopped assisting or tending to the patient. Nobody was there for the patient in his acute state anymore.

The patients’ family took him out of this hospital, and straight into the next hospital, where the doctor at the emergency room frowned: “We know that doctor, he likes to do surgeries”. The patient eventually got sent home with some painkillers (!). Surgery was declared as not imminently essential, but could potentially be considered in the event of a recurrence of symptoms, which may or may not happen.

Was patient health, in this case, really the prime focus of doctors doing, or were there economic factors dictating behaviour? Remember that patient healthcare, is to be paramount to conventional practitioners, and they swear to honour it in their Hippocratic Oath?! How on earth could a practitioner not disclose patient data, test results, exam images, and exert pressure to convince a patient to undergo surgery?

2. Another patient shared the following story, which permits a similar trail of questions. This patient had been admitted to hospital. The one doctor visiting in the morning interpreted the patient data as such that he found surgery to be absolutely unavoidable. He scheduled the surgery for the following day. The visiting doctor in the evening stressed that the patient was improving and surgery was absolutely not necessary. How can a patient make an informed decision from such statements? Which doctor can be believed; whose statement is correct? How can a patient decide for himself, what the best healthcare decision is in his state, if one doctor says we do surgery now and the other says no way?

There is a discrepancy here!

3. The following case emphasizes why one must always be critical! A patient, a middle aged man, slightly corpulent, but not excessively overweight, sought help from a cardiologist for symptoms of angina pectoris. The doctor, an internationally known expert in the field of cardiology, looked at the patient, told him that he was too fat, prescribed Statins and concluded with the words: “If you do not take these you will die!”. The patient objected, as he did not quite understand why he should be taking Statins, as there were no clinical indications of them being necessary. Test results had shown no arterial deposits or elevated cholesterol levels. Somewhat shocked by the ‘impending death unless…’, the patient stated that he was also concerned about the potential side-effects of Statins. The cardiologist belittled the patients concerns, stating that the patient should not believe the media reports on such adverse-effects. He insisted that the efficacy of Statins was long proven, and that the patient could safely trust his prescription.

Ehhh? How safe is a prescription when there is no true indication for it? And have not just recently Statins been slammed for their adverse effects and not so beneficial impacts? What has the employment of fear to do with ethical comportment? Has it become a tool in the medical industry? It appears that monetary factors are increasingly becoming the prime importance over patient healthcare, and the fight for patients is evolving to somewhat of a dirty business. This is indecent and irresponsible, and reflects the attempt to make the patient submissive to the will of an industry!

But, what is happening out there? The doctors are the helpers in need, the sick patients hope for recovery, and here they are exerting pressure, keeping information from the patient, and threatening him or her with death if their will is not complied with.

Sadly, doctors are still frequently seen as ‘Gods in white’, and their recommendations and suggestions are all too often accepted as best of choices, and most competently made decisions. Hardly ever are doctors orders questioned or analyzed for their appropriateness. Most patients rely on, and trust what their general practitioner says. Most believe that their doctor knows best, mainly because they themselves are not knowledgeable in the specific field. Therefore, they trust the assumed competence and integrity of the medical professional to make the best choices for them, and to suggest the most appropriate treatment protocol. But, the above cases have illustrated that the patient must not be submissive to doctors orders unless they are convinced of what has been suggested as best for their cure and well-being. It is necessary for patients to critically question what their Conv.med. Practitioner recommends!

The above mentioned examples are hopefully only isolated cases of prejudice in the patient / orthodox practitioner interaction! But, they are scary descriptions of ‘how-not-to’ comportment in the so-called trusted union of patient and medic.

I have huge respect for the work that allopathic doctors are conducting. They have much responsibility resting on their shoulders when patients are placed into their care. But, as a patient, I wish to be respected, be informed, listened to, and treated by the best possible therapeutic regimen that has the greatest potential to reinstate my health in the fastest and least invasive way! I do not wish to be rendered ‘under-age’, minor, or deprived of the ability to maintain responsibility for my own healthcare, of making my own informed decisions.

I very much hope that the above incidents are only extreme snippets and do not represent a trend in the medical industry. Albeit the fact that money has become a primary factor in healthcare I do hope the Hippocratic Oath does not lose its premise and remains a commitment to the representatives of the medical profession. It is a question of integrity and respect, to act responsibly for someone ill and vulnerable, who has entrusted his recovery and healthcare to someone competent in his stead.

This should not be forgotten!

The Dilemma with Ethics

01 Sunday Apr 2012

Posted by Uta Mittelstadt in Ethics

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Autonomy, Beneficence, CAM, Ethics, Healthcare, homeopathy, Justice, Non-maleficence

Within the health care profession, as practitioners, we find ourselves in a sector that is subject to the most intensive and sensitive regulation. We are entrusted with the highest good of all, the life of human beings. This confidence in our credentials requires sincere monitoring, directing, and legislative and ethical boundaries. We are dealing with a patients´ most vulnerable existence, illness, a state when his vitality is weakened by imbalance.  Whether practicing in general medicine or complementary and alternative fields, we are all dealing with this highest good and have to prove our worthiness and are required to abide to the rules that assure the patients security.

Samuel Hahnemann laid out the initial rules of professional practice in the field of homeopathy, in his first aphorisms of his Organon [1]. Aphorism 1 states that it is a practitioners´ highest good and only profession to retrieve the sick man from illness and render healthy again. Aphorism 2 then tells us that the highest ideal of curing is to do it quickly, gentle and such that the healing is of permanence. We are to remove and abolish in entirety the disease and are to do this most rapidly, reliably and following precise, comprehensive motives. These words can well be translated into our times and are contingent to many professional codes of the health practices, ever since first pledged in the oath of Hippocrates [2]; and today manifest in the declaration of Geneva [3]. These phrases constitute the ethical principle of beneficence.

Beneficence, whether to the allopath or the homeopath, in practice, means the same thing; that it is our duty to our patients, to act in their best interest and to do good [4]. But at the same time of laying out an ethical boundary for the practitioner, it is here perceivable that these boundaries are liable to flexibility. Because, with Beneficence, what is good for the patient is left to be declared by whom? Is the practitioner competent enough to explain to the patient all aspects of a therapy such that he, the patient can make the decision for or against a therapy himself? Is the autonomy, the ability of the patient to actively make his own decisions [5], at all times sustained with the patient? What about non-maleficience, that requires us to do no harm to our patients [4]? With vaccinations, for example, patients are receiving injections of a harmful nature. Is the general practitioner committing non-maleficience?

For a general practitioner abiding to the code of ethics seems slightly more complicated than it is for the homeopath. What if the general practitioner has to treat a patient that is brought into his care unconsciously [6]; who decides on beneficence and where does that leave autonomy? An overall rule that needs to be followed is that whatever a practitioner decides on, the benefits of a treatment have to outweigh the risks.

In homeopathic practice, to fully explain to the patient all aspects of homeopathy and all effects that a remedy reaction may bring forth would exceed the time available for a consultation. So are we practicing unethically? We cannot possibly provide all information that there is. But we are required to provide enough information for our patient to understand and be able to make an autonomous decision [7].This decision the patient then makes has to be respected, even if it should, to our beliefs, be inappropriate to the patients´ positive health development. We are complying with the principle of autonomy. But it is here that beneficence and autonomy may clash. Especially in general medicine, this clash is apparent, so for example where patients need, yet refuse to have a blood transfusion because their religious believes prohibit them to [8]. In order to protect the practitioner it is therefore, important to have the patient sign a consent form where he declares his abstinence from treatment or therapy. Likewise if the patient wishes to proceed with a treatment, in order to protect the practitioner, the former should have to sign a form of contract where he declares his approval and understanding of the procedure and the possible consequences [5].

Where such “contracts”, or consent forms, have not been signed, from a legislative aspect, a practitioner may be exposed to claims of civil liability. This may also occur where tort of negligence of the practitioner towards the patient is claimed. But to be proven guilty of negligence the principles of negligence must have been violated. 1. To owe a duty of care, 2. To breach that duty,3. This breach of duty must have caused the damage complained of [9].

What about ethical justice? Are we able to provide our services to everybody on equal terms [5]? The diverse health systems of many countries have shown us that this is impossible. We already have medical systems today that at the most provide essential medicinal services rather than fulfil the necessary requirements [10]. The discrepancy in the health care system lies in deep confrontation to the ethical principle of justice which states that all patients have to be treated equally and have to be given access to the same resources [5]. Therapies of complementary and alternative practice though are not integrated into the health care systems and have to be disbursed privately by the patient and are therefore not obtainable for every patient. From this point of view justice is not met.

The issue of ethics is not a simple one and it is evident that stretchable boundaries are necessary. To assure that these boundaries are maintained, a health care professional is a member of a board or society monitoring professional practice within the practitioners´ field of competence. Ethics is the code of behavior that guides our actions in our professional environment [11]. To abide by these rules is essential for any practitioner in the health care sector. What is important to remember is that at all times the benefit has to outweigh the risk.

So can we as homeopaths, meet the ethical demands that our professional body codified for us, fully and at all times? We have to attempt to fully comply, but have to accept and be aware of the fact that the ethical principles overlap and their restrictive boundaries are slightly flexible.

[Thanks to Jean Duckworth, University of Central Lancashire, for assistance with this assignment]

References:

[1] Hahnemann, S., 1974. Organon der Heilkunst. 2te Auflage. Heidelberg: Karl F. Haug Verlag.

[2] Bauer, A., Anon. Der Hippocratische Eid [online] last accessed 24 January 2009 at URL http://www.rzuser.uni-heidelberg.de

[3] Jones, D., 2006. The Hippocratic Oath II [online] last accessed 09 February 2009 at URL http://www.catholicdoctors.org.uk

[4] Pantilat, S., 2008. Beneficence vs. Nonmaleficence [online] last accessed 05 February 2009 at URL http://missinglink.ucsf.edu

[5] Swagerty, D. Anon. Ethics: Terms [online] last accessed 10 February 2009 at URL http://classes.kumc.edu

[6] Davenport, J. 1997. Ethical principles in clinical practice [online] last accessed 05 February 2009 at URL http://xnet.kp.org

[7] Ernst, E., Cohen, M., and Stone, J., 2003. Ethical problems arising in evidence based complementary and alternative medicine [online] last accessed 19 January 2009 at URL http://jme.bmj.com

[8] Gardiner, P., 2003. A virtue ethics approach to moral dilemmas in medicine [online] last accessed 07 February 2009 at URL http://jme.bmj.com

[9] Duhaime, L., 2006. Negligence an Introduction [online] last accessed 07 February 2009 at URL http://www.duhaime.org

[10] Schulz-Ehring, F., Weber, C., 2008. Zwei-Klassen-Medizin [online] last accessed 24 January 2009 at URL http://www.pkv.de

[11] Fieser, J., 2006. The Internet Encyclopedia of Philosophy [online] last accessed 10 February 2009 at URL http://www.iep.utm.edu


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