Arguments Against Doctor Gatekeeping

Katz states, “the conviction that physicians should decide what is best for their patients, and, therefore, that the authority and power to do so should remain bested in them, continued to have deep hold on the practices of the medical profession “(214).

It has been widely accepted that rationing of the National Health Service (NHS) is paramount to maintaining and balancing public resources. In a utopian world it would be possible to provide every patient with every medical treatment that they would require, however this is not possible and therefore rationing has to be applied by local health authorities. Simply, there are not enough resources and medical staff available to keep up with the ever evolving demands of the public, and once more, these medical resources can’t at times tend to the needs of the medical advancements made every day. Some equipment and medicines are extremely costly and the NHS struggles to balance public budgets in the face of such advancements. One survey of a primary care trust in the NHS found that the panel that made that decision about funding new treatments was faced with applications that would have

ii. Unconscious physician bias. Another theme in the reading that related back to class was the unconscious biases of doctors influence their interactions with patients, with consequences for patient outcomes. These unconscious biases affect interaction through the doctor’s communication. Establishing a basic understanding of treatment and diagnosis can foster better patient outcomes. An example of unconscious physician bias was Abraham 's focus on former secretary of the Department of Health and Human Services, Dr. Sullivan, in chapter eight. Dr. Sullivan’s campaign focused on the individual choice in adopting healthy lifestyle choices from diet to exercise. Skipping over racial disparities, the unconscious bias inferred through his words was that he considered the patient to blame whenever they fell ill.

him procure more. Doctor as a flawless operators will act as indicated by the patient wellbeing and

- The strength/validity of this argument is how Trumps administration's plan will make foreign doctors want to leave the US and prevent new doctors from coming as well. The suspension of Visa's will prevent doctors from wanting to travel to rural communities because of the renewing process of their drivers licenses. Resulting in fewer doctors to assits with health care, which will begin to hurt the rural poor first and eventually harm more individuals in the states due to less doctors.

Physicians ironically may seek the progression of initially manageable diseases, such as type-2 diabetes or heart disease, so that the patient eventually falls at the mercy of costly procedures in order to survive. Doctors “charge per action, diagnostic or curative, taken on the part of a patient,” which provides much greater short and long-term monetary rewards in comparison to immediate communicative prevention. (El-Sayed) Medical students typically enter the field thousands of dollars in debt due to extensive educational costs and are keen to choosing the most profitable fields, such as surgery. However, this hefty profit relies on straying patients “away from primary care, where disease prevention can happen, toward specialty care that is ultimately more expensive and less efficient.” (El-Sayed) Patients are to suffer unnecessary medical and financial burdens at the hands of individuals whose supposed moral purpose is to alleviate such problems in the name of their

“Rationing is the allocation of scarce resources, which in health care necessarily entails withholding potentially beneficial treatments from some individuals. Rationing is unavoidable because need is limitless and resources are not.” (Scheunemann & White, 2015). I believe everyone deserves proper health care regardless of his or her statue. Unfortunately there may be barriers to providing healthcare to those who cannot afford it. When I became a nurse I made a promise to follow the Nursing Code of Ethics. I vowed to provide my patients with autonomy, beneficence, fidelity, justice, nonmaleficence, and veracity. Stanhope & Lancaster (2016) states, “Justice as an ethical principal for case managers considers equal distribution of health care with reasonable quality.

In our society and classrooms, more often than not, it is argued that when a physician and their patient have a paternalistic relationship, it is deemed unacceptable and needs to be addressed. However, Komrad argues that a paternalistic relationship can actually be a beneficial factor between a physician and their patient. Komrad creates the concept of a limited paternalism where it “preserves an individual’s freedom as much as possible in the hope of eventually broadening it” (42). One of the main components of this paternalism is acknowledging that from the very beginning of a physician-patient relationship, it is an asymmetrical relationship because of the patient’s already diminished autonomy. A patient has an automatic diminished autonomy

Constraining health costs can compromise the integrity of the patient-physician relationship and reduce the quality of care received by patients. Ethically, some of the techniques can undermine the physician's obligation to serve as the patient’s advocate. The Hippocratic Oath emphasizes the primacy of trust in the relationship between patient and physician. This oath obligates the physician to keep his/her patient's information confidential, to avoid mischief and sexual misconduct, and to give no harmful or lethal agents. To simplify, the physician becomes the advocate for his/her patient, using his knowledge and the patient's trust for the patient's good. Conversely, these new financial incentives force physicians to balance the interests of patients with their own personal interests. The fear of retribution from superiors for providing appropriate, but more expensive care has become a powerful force in distorting physicians' clinical judgment (Council of Ethical and Judicial Affairs,

Far from paternalism understood as a dogmatic decision made by the physician, James Childress in his book “Who Shall Decide?” further expounds paternalism into multi-faceted dimensions. Pure paternalism intervenes on account of the welfare of a person, while impure paternalism intervenes because more than one person’s welfare is at stake. Restricted paternalism curbs a patient’s inherent tendencies and extended paternalism encompasses minimising risk in situations through restrictions. Positive paternalism promotes the patient’s good and negative paternalism seeks to prevent an existing harm. Soft paternalism appeals to the patient’s values and hard paternalism applies another’s value over the patient. Direct paternalism benefits the person who has been restricted and indirect paternalism benefits a person other than the one restricted. Whatever the case may be, the guiding principle of modern paternalism,” says Gary Weiss, “remains that the physician decides what is best for the patient and tries to follow that course of action” (1985; p.184). That the physician determines ‘what is best’ is questionable. The medical profession’s back-to-basics

Wilson and Dr. Cameron is paternalistic. That is, the physician is expected to do what is medically best for the patient. Dr. Cameron is concerned about Mr. Wilson’s economic stability however, she should be concern about his health and rather then prescribing a medication that is cheaper she should try to find a way to provide the medication to the patient. Paternalism and beneficence are important in the physician-patient relationship because of the physician’s superior technical knowledge and access to pharmaceuticals and medical technology. Despite the importance of patient involvement and informed consent, physicians are expected to do what is best for their patients regardless of the

Dr. Peter Mack, a surgeon in the Singapore General Hospital, discusses utilitarianism from a different perspective, relating it to the dilemma often faced by physicians where they have to choose between what is good for one and what is good for many. Even though physicians are trained to treat each individual patient as an isolated case that deserves equal attention and allocation, the harsh reality is that there are times when healthcare professionals are faced with limited time and resources, and must decide how distribute them fairly (Mack). He justifies his decision to call on Utilitarianism in such cases, mentioning three of its components of maximization, consequentialism, aggregation, and welfare.

Gatekeeping is a core concept in a primary health care (Grumbach et al.,1998). One of the several key aspects of gatekeeping is to guard patients that have direct access to specialised care (Bodenheimer & Grumbach,2009). General practitioners and other primary care professionals are signified to be gatekeepers (World Health Organisation,2000). Starfield.B (1992), Grumbach & Fry (1993) and Bodenheimer & Grumbach (2009) points out responsibilities of primary care professions (gatekeeper) first, they are to encounter the patient’s health care (Starfield B.,1992) and proceed ambulatory care (Grumbach and Fry,1993). A gatekeeper is the decision maker for opening the gates to a further specialised field after proceeding fundamental primary care on a patient hence, patients are not entitled to direct their own specialists. Also, their purposes are not just to take care of the patient’s wellbeing but giving extensive treatment if any is required (World Health Organisation, 2000) such as, minor illness which includes skin disorders, respiratory infection, headache and common flu, also includes preventive care; vaccinations, immunization and prenatal care are some of the common examples (Heinemann,1980).

The main concern of doctors is that patient safety could be jeopardized as well as the quality of care. Some physicians fear that NPs and PAs will make more mistakes because of their lack of education. Some suggest that they may order more tests than necessary due to lack of confidence in their diagnosis. There is accusations that the reason physicians are against independent practice is because they are afraid they will lose business and an issue of professional pride. “This is not primarily a question of lost income to family practitioners. The main concern is an erosion of clinical expertise, which may result in a decrease in overall quality of care,” according to Dr. Dorio, an interventional radiologist in Florida (Page, 2014). Other physicians

In the world of medicine, many things tend to unintentionally go wrong. However, in many instances these things knowingly happen. Many health practitioners and people alike tend to wonder why patients leave or put their health care on hold despite of a medical professional’s advice. Many patients and people tend to wonder why they or their loved ones were discharged too early, or without sufficient medical care, There are many reasons as to why a patient would leave against medical advice, but not many valid ones for discharging a patient without proper treatment early. The questions in these cases are, what drove them to decide that course, and why?