The healthcare field is often faced with many ethical dilemmas that are not easy to navigate to a solution. Moving forward with EHR technology and the consolidation or practices new ethical dilemmas will arise.

Ethical, Financial, and Logistical Dilemmas

The United States healthcare system is evolving rapidly. According to federal officials, over eight million people are newly insured and Medicaid eligibility has expanded to 26 states. Networks are being built and hospitals are consolidating as many doctors move away from independent practice. Combined with the never-ending concerns of malpractice lawsuits and misinformed patients, doctors are struggling to keep their practices relevant. Medical Economics has created a list of four ethical, financial, and logistical dilemmas that doctors have to navigate on a regular basis:

Ordering unnecessary tests: According to findings from an ABIM Foundation survey of 600 physicians, 53% of physicians have stated that they would order an unnecessary test for a persistent patient.  52% of those surveyed cited malpractice concerns as the main reason for such a decision with 36% saying it was “just to be safe” and 30% claiming they wanted more information in order to reassure themselves. Arguing with a patient can be time-consuming and harmful to the patient-provider relationship. Also, if a patient’s concerns were valid but the test was not provided, there is the risk of a lawsuit. By establishing strong communication early on, these problems can be avoided.

Pressure to refer patients within the health system: 60% of physicians still practice independently, according to an American Medical Association (AMA) survey. However, by 2012, 29% of doctors worked for a hospital or a practice that was at least partially owned by a hospital. Working for an integrated network has its advantages. However, these networks often push to keep patients in their system. While doctors may feel pressured to promote the teamwork and quality of the integrated system, there are times where it makes more sense for a patient to be treated by someone outside the system.

The ethical responsibility of treating Medicaid and ACA patients: According to a 2013 survey by Merritt Hawkins, 45.7% of doctors accepted new Medicaid patients. Medicaid reimbursement varies across the country and doctors have to decide what works best for them financially. Treatment for ACA patients comes with risks that some doctors aren’t willing to chance. The plans with the cheapest premiums also tend to have some of the highest deductibles. Many physicians are concerned that their patients may not be able to afford it. Accepting a couple of newly insured Medicaid patients, implementing additional efficiency measures, and continuing to treat patients whose coverage has moved to one of the ACA health exchanges, can all help doctors meet the increasing demand.

Meeting patient demands: Patients are known to be rather persuasive. The ABIM Foundation survey found that 28% of the doctors surveyed claimed that a patient insisted on a test and 23% reported wanting to keep their patients happy. 13% felt that their patients had the right to make the final decision when it came to their health. Often these concerns can be solved through a simple conversation with the patient about why they feel these tests or procedures are necessary. The physician can then explain why the test or medication isn’t needed.

Author: Lauren Daniels

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