Non-Compliant Patients

Fat Doctor wrote a great post about a couple of crazies in the ER.

But then there is another way of looking at it.

Fat Doctor's patients each refused an obvious course of treatment or investigation that does not even remotely approach an area of controversy in medicine. All patients have the right to refuse treatment or investigation. As Fat Doctor herself admits, there is also the little issue of her own obesity, which is generally accepted as a condition associated with unhealthy lifestyles.

I guess the physician's frustration is raised by the question of why someone would seek treatment if they are not willing to accept the recommended treatment. But the fact remains that it is everyone's right not to do the right thing, or what an expert says is the right thing. I've been beating the market lately, not listening to financial advisers. At least this was the case last week; next week may be another story. I'm taking my chances.

But in the case of the market, my adherence or non-adherence to recommendations does not affect everyone else. I gain or lose financially as a consequence of my actions and I am the only one to gain or lose. In health care that is not the case. Moreover, many decisions yield consequences well beyond the capacity of the average person to pay. If a diabetic makes poor diet choices and has a heart attack, someone else pays for the care, either through insurance or the inadequate mechanisms available for uncompensated care.

Also consider that another individual without diabetes, who has always made the right health choices may still get a heart attack.

Saying that it is more likely for an uncontrolled diabetic to suffer a heart attack is not the same thing as saying that the diabetic brought it on herself. Such are the vagaries of chance and genetics and since no genetically perfect human being exists to our knowledge, we should all be living in fear of discovering our unknown weaknesses.

Some ideology might require we reject the notion that people should be sheltered from the consequences of their poor choices. Other ideology would lead the government to insinuate itself into people lives with instruction, education and prerequisites for benefits.

Somewhere in the middle are physicians who morally, ethically and legally obligated to treat everyone in an emergency, regardless of the ability to pay. At least that's how I read the Hippocratic Oath and its contemporary application. Universal coverage would help the country's physicians do what the people need them to do and the doctrine of personal responsibility is insufficient to reject the idea. When we reflect on the causes of heart attacks, cancer and the multitude of killer conditions out there, maybe they are complicated enough that non-compliance is an insufficient reason to condemn a patient.