Monday, March 2, 2009

Live With the Consequences of Your Actions

Scalpel or Sword is one of my favorite ER blogs, and I usually find myself agreeing whole-heartedly with what he has to say, but today, I found a post I couldn't support.  His premise was that it is okay to not be completely accurate on the medical record so that a patient doesn't risk losing their insurance plan.  Go read the post.  Here is the comment that I left for him:

I'm also scared of socialized medicine, and wouldn't vote for Obama even if he offered me a 13 dollar per week tax cut, but the principle of accepting the consequences of your actions are solid conservative principles.

If you don't want to find yourself down on the list of kidney transplant patients, then here's some advice: STOP DOING DRUGS!

The idea that people can do whatever they want and get away with it is a solidly liberal principle, and quite frankly, I'm a little shocked that you would go along with it.  You don't have to go tell the cops, but if a patient comes in with a very real health problem (even if it isn't the reason they gave for their visit) and you ignore it, are you really doing them a service?

When they come in with a near-fatal overdose in a month and the attending doc has no history to go by, will you have done her a favor?  When she is living on the street thanks to a habit that could have been broken early on with some help will you have done her a favor?  When she needs a liver transplant due to the alcoholism that so often accompanies drug use, will you have done her a favor?

I'm not trying to say that you will be responsible for any possible downfall that she may take, but when you seek to cover the sins of another, you are certainly not doing them any favors.

What do you think?

1 comment:

scalpel said...

If I can diagnose her problem when she has very subtle manifestations of intoxication, I expect that the next doc should be able to diagnose and treat her appropriately if she has a "near fatal" overdose. Admittedly it would be easier for the next doc if there was a notation of cocaine use on the old record, as long as she presented to the same facility (or one on the same network).

I wouldn't feel guilty if she ended up on the street, because like you said, we are responsible for our own actions. I treated her appropriately no matter what the documentation revealed.

If she ends up needing a transplant at some point, then yes indeed I might have done her a favor. The question is, have I done the right thing for the other patients who she might pass in line? I rationalized that by considering that the other (transplantless) patients were not MY patients.

I only have a duty to MY patients, not to society as a whole. That's why I can preach about the evils of socialism but still advocate for each of my individual patients, and how I occasionally justify writing antibiotic prescriptions for upper respiratory infections when they might possibly help my individual patients despite potentially causing harm to the rest of the world.