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Many Doctors Withhold Info From Patients
By
LAURA MECKLER Yahoo
News, July 8, 2003 WASHINGTON - Nearly one in three
doctors reports withholding information from patients about useful medical
services that aren't covered by their health insurance companies, and the
number may be on the rise, a study reports. Study authors say their work offers the
first empirical evidence for what many have long suspected: that coverage
limitations imposed by managed care are infiltrating doctor-patient
communications. "Patients aren't getting the whole
story," said Matthew K. Wynia, director of the Institute for Ethics
at the American Medical Association and lead author of the article being
published in the journal Health Affairs. Wynia and his colleagues surveyed 700
physicians and asked how often they had decided not to offer a
"useful service to a patient because of health plan rules."
Forty-two percent said never, and 27 percent said rarely. But 23 percent said
"sometimes," and 8 percent said "often" or "very
often." The results harken back to several
years ago, when some managed care companies barred doctors from discussing
medical options not covered by the health plan. Public outcry persuaded
most companies to drop those rules, known as "gag clauses," and
many states banned them from contracts. The study found that doctors whose own
salaries are closely tied to controlling costs were more likely than other
doctors to report withholding information. In addition, those who serve a large
number of Medicaid patients were more likely to stay silent, as were those
who believed patients might want them to deceive their insurance companies
to get services covered. Authors note an important caveat: The
term "useful service" was not defined in the survey. To one
doctor that could mean steering a patient to a generic drug rather than
the more expensive brand-name version, while to another it could mean not
mentioning a major surgical procedure. The most positive interpretation of the
study's results would be that doctors are withholding information on
services that might be useful but are less clearly necessary than others,
said Dr. Hoangmai Pham, senior health researcher at the Center for
Studying Health System Change, who was not part of the research team. The most negative interpretation, she
said, is that doctors have been conditioned to withhold information,
shortchanging patients. All of it can be compounded by time
pressures, Pham said: Doctors with a limited amount of time with a patient
may not spend it talking about services that the patient has no way to pay
for. "It's simply not possible to discuss everything with every patient," she said. "You might go down your list of three or five top options but not discuss every last one." Copyright
© 2002 Global Action on Aging
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