MEDICAL PROTOCOL OR ETHICS? WHICH COMES FIRST?

DO NO HARM?
Johann Wagener 11-26-13

I walked out of a doctor's office today after deciding to cancel my appointment for fear of what I might have said to him; better I come home at put the fingers to keyboard.

As I was driving home I thought about how to address this situation. It seemed to all boil down to "protocol vs ethics.

Here is how I got here.

I belong to what I consider a top notch HMO that actually put patient care before profits.

So, when I was referred to an orthopedic clinic for an evaluation by an orthopedic surgeon I assumed, as I always had previously, that I was being put in good hands.

I arrived early as requested, filled out a lengthy questionnaire, including several documents regarding "financial" responsibilities and a long list of questions regarding the family tree which I could not correlate with the injury I had sustained.

I also came armed with 2 MRI studies, along with written reports from the physician who interpreted the data and and cited his diagnosis. I made an assumption that these would be reviewed, either during, or before my visit with the orthopedic surgeon. I again assumed, from previous experience with other physicians, that this data would come in handy in treatment planning. Both assumptions seemed reasonable and logical to me.

As it turned out, I was grossly mistaken.

Besides completing the intake form I was asked to submit to 2 X-rays prior to consulting with the surgeon. It seemed a bit curious to me because screening tests are usually run past the HMO who then determine whether or not to proceed and, if approved, are always referred to "off-site" diagnostic clinics and labs.

I then made another assumption, and again found myself with egg on my face. I mistakenly assumed that the orthopedic surgeon might have accessed these reports online (which many do), already reviewed the MRI's and read the reports, but did not think they were conclusive.

So, I asked the staff person, "why the x-rays?" To which she simply answered, "It's protocol".

That set me back in the chair a little, so I asked her to elaborate a little. She then proceeded to tell me that this orthopedic surgeon insisted on 2 X-rays from patients "prior" to consulting with them and added, "just in case surgery is indicated."

I now sank into the chair, wondering how the leap from a 1st visit consultation without reviewing even my intake sheet, let alone the MRI's, this surgeon was already considering surgery??????

I made one last effort to make sense of what I was being told and asked; "would it not be better to review the MRI's and the diagnostic report before ordering more tests or procedures?"  And, how, pray tell, would an X-ray show more than an MRI?

How is an MRI different than an X-Ray or CT scan?

The response I received was jaw dropping. "Sorry, but this doctor's protocol (that word again) requires that I have 2 X-rays prior to him consulting with me; no exceptions, sorry.

Now I know the "freedom hounds" will respond to the dilemma I'm experiencing with a lot of constitutional references like "You're free to see any doctor you want (as long as you don't support Obamacare) and the Doctor is free to accept or reject any patient he chooses to (unless Obamacare is implemented). I'll also be advised to not make a big deal out of it; just move on...no harm, no fowl. Really?

So I made my choice; I cancelled the appointment.

Doctors Cost Medicare $100 Million By ‘Self-Referring’ Their Patients For Profits