One Doctor's Answer to Managed Care

As your physician, it's important to me that you know my feelings about the financial issues in our relationship. It's especially important that you understand how I deal with the ethical conflicts that may arise from insurance plans and other financial influences upon the decisions we make together.

My greatest wish as a doctor is that you judge my care to be the best possible, according to your personal standards. For this to happen, I. need to earn your trust as an ethical person, as well as a skillful practitioner. I want you to know that, among the values that govern my practice, I make the following promises to you:

• I will treat you as a person, first and always, and not as a means of creating profits for me or anyone else.
• I will never deceive you about my motives or intentions. I will not withhold information I believe you should have when I recommend a plan of treatment.

My advice will always consider first what is best for you as a person, regardless of its financial implications for you, your insurance company or anyone else, including myself.

• I believe in cost-conscious care as a secondary goal of a good health system. I will be sensitive to financial issues that affect you. I will help you discover the costs of treatments and assist you in finding the most effective uses of your money for the sake of your health. I will help you distinguish between decisions based on costs as opposed to other factors.
• Regardless of the payment arrangements between us, every treatment or recommendation that I provide will be based on my belief that it is in your best interest. I will not participate in any plan that offers me compensation so heavily weighted toward cost containment that it could create a temptation to place this factor above your welfare. Nor will I offer you treatments on a fee-for-service basis that are inappropriate or unnecessary, or at unreasonable fees.
• As an incentive to bear costs in mind, some insurance plans base a portion of their payment to me upon their savings from services you do not use. Their intent is to reduce thoughtless and unnecessary treatments. However, I will disregard this incentive until we have considered all treatment options.
• Occasionally, a procedure that may have little hope of benefit or that may not normally be "covered" by your insurance might still be appropriate for you to consider. I will support you in asking your insurance plan to pay for any reasonable treatment, regardless of plan policy And I may also encourage you to pay yourself for "uncovered" items that I believe offer valuable benefits not available under your plan. However, I will advise you against procedures that are wasteful, frivolous or irrational.
• If I foresee a conflict between your welfare and any policy, contract, guideline, standard or law, I will disclose it to you. In the presence of uncertainty, I will help you choose a course of action that recognizes your values. On medical issues, I will not place my personal interests above yours, nor will I cooperate with others in doing so.
• Finally, if I feel that you or anyone is contemplating a course of action that is not in your interest, I will advise you of this.

I participate in managed care plans because many people have no other access to medical insurance and because I believe that well-managed care is far superior to traditional, "un-managed" care. Whatever form your health coverage takes, I intend always to deal honorably with you, your insurance company and everyone else in the system.

Please let me know if at any time you have a concern about the completeness, accuracy or bias of any information you have received from me, my staff or any consultant or organization to whom I have referred you.

Dr. Paul Ehrmann
Adapted with permission from Michael S. Victoroff M.D.