Insurance vs. Diagnosis

Imagine a scenario where you suspect you have a debilitating illness. You have had scary symptoms, like shaking uncontrollably and randomly losing your balance, for almost a year. You have never seen symptoms like this before and you are scared. Your latest symptoms provide more insight into your disease and the doctor says that he finally has an idea what may be the diagnosis.

To confirm the diagnosis he must do some imaging. However, if he does the imaging and the imaging supports the diagnosis, then your medical record will show that you have a chronic condition. Your doctor advises you to get disability and health insurance before you get the imaging done because it will be much easier and cheaper if you get the insurance while your records say that you are healthy. However, this means you will have to wait for several more months before you know if you actually have the disease.

Did the doctor do the right thing in this scenario? He is giving his patient the opportunity to acquire affordable insurance before he confirms the diagnosis. If I was the patient, this is the scenario I would prefer. However, there are patients out there that are very anxious and want to know what their illness is immediately. For them, that anxiety outweighs the potential benefit gained from getting their affairs in order.

As usual, the right answer in this scenario is to present all the information to the patient and let them decide...even if it seems like the patient may be making life harder for themselves with their decision.

Futile Care

We discussed futile care in our ethics class today. Apparently we, physicians, are ethically obligated to provide futile treatment (e.g. ventilating a brain dead patient) if the patient or their family want to continue treatment. The justification behind continuing treatment is that the treatment provides psychological benefits for the patient's family.

In a world with limitless resources, I can understand this justification. However, in the REAL world, we already have tremendous hospital wait times and not enough beds for our patients. Keeping a patient "alive" (I use quotation marks because we don't know how alive a brain dead patient truly is) means there is one less bed and fewer resources for another patient. Thus, by delaying the inevitable passing of one patient, we are prolonging the suffering of another.

Obviously, the ethical issues in this scenario are not clear cut. The family of the brain dead patient may think that they are getting air access to health care if their physician decides to terminate treatment because it is futile. Also, what if the physician is wrong (it's been known to happen) and the treatment isn't futile? Or what if you can keep the patient alive for another year, and within that time a new technology is developed that can heal the patient?

There are many interesting dilemnas involved in futile care...I wonder how my experiences through my medical training will change my views on the issue...