At what point does selling products to patients become exploitation?
Consider the physician who begins the appointment by saying that the patient appears to be holding his neck in an unnatural position. The patient has come for help with fever and congestion and gets asked first if his back or neck ever hurts. The patient ends up spending three hours in the doctor's office, gets a chest x-ray that is used for what it shows about his back, and hears six times as much information about spines and what chiropractors can to do than about the reason for the visit. Then, when the patient finally is being allowed to leave, it turns out that the chiropractor next door has an opening at that moment. It appears the patient has been kept in an examination room until the time of the vacancy in the chiropractor's appointment book. The doctor does not present it as an option, and does not ask if the patient wants it, but reaches for the phone to tell the chiropractor that the patient is being sent over.
Consider the orthopedic surgeon being seen for the first time by a patient on a Friday afternoon who tells the patient that surgery is needed and can be performed on Monday morning. That leaves no time for the patient to get a second opinion, no time to try to learn anything about this particular surgeon, no time to consult with family and friends and research whether surgery is the best approach for solving this problem (it wasn't).
Consider the dentist who tells all patients that they should be using vibrating toothbrushes and then happens to have an expensive model available to sell. Patients not used to declining the advice of their dentists buy them. Many use them only once. Patients not used to returning products to dentists, as they do to retail stores, often throw them away.
When caregivers are the source of the information
Each of these instances may or may not be abusive, but each can make patients less trusting and less compliant consumers of health care. Health care providers complain about patients who don't do what they tell them to do, but what do they expect when they teach patients not to trust what they say?
There are dentists who sell crowns that patients do not need. There are pharmacists who purchase gray market drugs or who "miscount" the number of pills being put in a bottle. There are physicians who do surgeries they've only read about but never practiced, and who do them in communities where specialists exist to whom patients could be sent.
Small and large exploitations occur in medicine everyday. No one records them. No one counts them. There isn't any advocate to whom patients can complain about them. There isn't even anyone in patient safety circles giving serious thought to the problem. Patient safety is defined in terms of errors. Abuse and exploitation are not on the map. It is assumed that health care professionals are objective and honest and selfless and the only problem is the infrequent, innocent error. So mechanisms are established only to account for those, when such mechanisms cannot account even for those.
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Among major industrialized countries, the USA ranks last in quality, access and efficiency according to the Commonwealth Fund, a health care research group. Health care is not run to maximize safety and healing. It is run to maximize profit in an environment where patients have no ability to determine who is safe and who is effective and who is affordable.
Patients have no choice but to do what they are told and then pay what they are told no matter how poor and expensive the service might be. There is no way they can determine if someone else might be better or cheaper. There is no way they can become a market that seeks that which does not kill and bankrupt them in unacceptably large numbers. There is no way they can cause bad operators to go out of business. They only can be hapless victims hoping they are among the lucky ones who survive.