Your Medical Care Choices Steer Your Health Outcomes

Photo by National Cancer Institute on Unsplash

Most people have heard of informed consent. Who hasn’t appeared for a clinic appointment and had sheets of paper shoved at you during check-in? Does anyone really read those sheets before signing them? And if you do read them, what would happen if you found a clause you didn’t like and asked for it to be removed? Would any healthcare organization allow the patient to selectively draw lines through some clauses and initial the deletions? Doubtful, which leads patients to just sign whatever they’re given.

So, What Really Comprises Informed Consent?

Informed consent is not about giving health care organizations free rein in what they do to you. It’s about choice — patient choice. Your choice.

Hospitals and payers (including insurance companies, Health Maintenance Organizations, Preferred Provider Organizations, Medicare, and Medicaid) have greatly eroded patient choice and, indeed, physician choice. These healthcare conglomerates have usurped patient ability to have the final say on whether treatment will be covered or not, and to choose which physicians you see. Insurance companies, HMOs, and PPOs should not have the ability to limit what physicians you may see and where you may get your health care but, under the current system, they do.

For patients, informed consent means understanding the purpose, benefits, and potential risks of the care being offered by the physician. That means the physician helps patients understand the treatment options being offered and the risks with the various options. With physician input, patients should be able to choose a mutually agreeable treatment plan.

Does this sound like fantasy? Well, for many of us, it is because the control of health care has been taken out of the hands of physicians and put in the control of payers who make decisions based on saving money, not the physician’s ability to provide top quality care.

Physicians Take Back Control Over Medical Decisions

Many physician groups are promoting putting healthcare decisions back in their hands — and out of the hands of payers. It’s a popular topic in Twitter’s medical community. Physicians used to be primarily independent, owning their own clinics, and some groups of physicians owned hospitals. Then, large corporate entities convinced congressional representatives that physicians would overcharge for their care if they owned hospitals. Of course, no one has noticed the large corporate healthcare conglomerates are doing the very same thing in spades. Statistics show that whenever a large hospital buys a smaller one, the price of the care provided immediately goes up.

Today the majority of physicians are employed by the clinics and hospitals they work for, and while many of these organizations would not admit it publicly, they pressure their employed physicians to refer patients to other physicians the organization employs — even if the physician knows there is a physician outside the network who could offer better care. So, it’s no wonder we don’t hear much about informed consent any more, except to sign away any rights to whatever happens to us at the hands of the healthcare conglomerate.

Physicians Are Obligated to Support Patients’ Choices

A key element of informed consent is the patient’s ability to have the final say in what care they choose, even if the physician believes another choice would be better. Physicians are required to support patient decisions. 

What happened the last time you asked detailed questions of your physician about the care choices offered? Were you supported in your search for more information, or belittled for questioning? Informed consent requires physicians support patient choice. Faced with lack of physician support for your decisions or questions, it may be time to search for a different provider.

Independent Physicians and Direct Primary Care

Today, some physicians are sidestepping insurances and offering to care for patients as a prescription service that is much less than what patients generally have to pay for insurance. Insurance deductibles of $6,000 far exceed the cost of what has become known as Direct Primary Care.

Unfortunately, insurance companies have lobbied states to prevent these physicians from practicing, claiming the subscription price of the service is “insurance,” and hence these physicians are selling insurance without a license. All states have to do for physicians to offer this kind of care to residents is pass a one-page clarification that Direct Primary Care is not insurance. Fortunately, the number of states that have acted to allow Direct Primary Care is growing.

Advocate for Yourself and Exercise Your Informed Consent

When thinking of informed consent, most people don’t think of choice as part of the equation. The next time you are at the doctor’s office and asked to sign paperwork, think choice, then make yours.