Thursday, April 9, 2009

Patient Autonomy vs. Doctor Autonomy

My last post dealt with the simple question of responsibility for one's own health. This follow-up is about one type of conflict which arises as a result.

A person called our office requesting to become a new patient. He wants be referred for hyperbaric oxygen therapy (HBOT) for an old stroke. He also stated that he is happy to stay with his regular doctor for everything else, but wanted to see me since he had heard I use alternative medicine. [note: I have that reputation as I do not argue with my patients over such "woo" unless I believe it to be harmful] 

I declined the invitation. 

The person later that day showed up at the Office front window and argued for 10 minutes with my receptionist about my decision. He only needed a referral to a nearby HBOT center and promised he would take little of my time. Oh, he also wanted to discuss other alternative therapies with me.

He had found a HBOT place in California, but didn't want to pay for the trip, motel, etc. Could he make an appointment so that I could convince the nearby HBOT center (2 hours away, only treating chronic wounds) to treat him for the stroke? "What kind of wound do I need?" 

I continued to decline, and he left unsatisfied. 

An individual has the right and responsibility for their own health. If unsatisfied with one doctor or practitioner or course of treatment, s/he is at liberty to find others to provide the health care sought (providing it is legal).

This man exercised his freedom finding a place for his desired legal treatment from the internet, but wanted a cheaper, more convenient outlet. I exercised my freedom by declining to be involved. He felt I was wrong to do so, that it is my job to help him obtain the health care which he has decided he wants, in the manner desired.

The patient has autonomy (self-rule) to make their own health care choices (within the law).

The doctor has autonomy to make his/her own practice choices (within the law). This includes the mode of practice and under the circumstances s/he decides.  

The self-rule of the patient does not give the right to rule over the doctor.

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