Our Federal Government Is Pimping Out Doctors

Warning to my physician: Don't discuss end-of-life decisions with me to make an extra buck

Medicare now has a regulation that will pay an incentive fee to primary care physicians who voluntarily undertake a discussion of end-of-life care issues with their patients during an annual exam. (This regulation was recently “back-doored” by Rep. Earl Blumenauer, a Democratic from Oregon, after a similar provision was removed from the landmark healthcare bill signed into law by President Obama in March of 2010. Lots of folks are upset about the sneaky way in which this regulation was crafted, and I’m one of them. I think it sends an ominous message that if “you can’t legislate it, you can regulate it” as a device for a lame-duck administration to round-end results that it can no longer broker through Congress. But that’s not the least of my concern.

Let’s take a look at how this regulation could impact the doctor/patient relationship. For starters, I thought it was a physician’s responsibility to discuss all options at a patient’s disposal for the care of any issue, without the extra profit incentive. There are plenty of different meds and protocols available to the health care consumer (that’s Washington speak for “patient”) from acne to cancer treatment. So what’s with the extra cash kicker? It’s designed to offer a profit incentive to doctors to discuss end-of-life issues during routine well-visits, or annual exams. You know, the ones where you’re not sick yet, not dying yet and not there to help put some additional cash in the doctor’s pocket. You’re not there to discuss your obligation as a caring American citizen to voluntarily remove yourself as a recipient of the ever-shrinking health-care dollar so someone younger and with a presumably longer life expectancy can consume those health-care dollars more efficiently. No, you’re probably there for an easy in-and-out checkup, for an itchy rash or a funny-looking mole or just to have your blood work done.

Don’t misunderstand, though; it’s not the discussion that upsets me. In fact, I’m hoping that when it is appropriate, timely and warranted, my doctor will discuss with me all end-of-life issues, even the painful ones that might suggest I decide how and when and where I manage a life-ending illness. I expect her to have that conversation with me in an ethical and professional manner, tempered with compassion and genuine concern during a time of tough decision-making. What I don’t expect, and will not tolerate, is any bureaucratic regulation that changes my relationship with my doctor into an annual forum for political agenda.

And so, to that end, rather than worry about what my doctor might say to me during the presumably many annual physicals that I will have after becoming eligible for Medicare, I intend to have this discussion with her:

“Doctor, I’m here to see you for my annual physical. I’m in the examination room, sitting up on the table in a paper gown with a cup of pee in my hand, waiting for you to come in and take my blood, my pressure and my temperature. We’ll discuss the latest medical, and yes, emotional issues going on in my life right now. Together, we’ll continue to navigate the course that we’ve been on for many years, together, toward good physical and mental health. But, until it’s necessary, I will be greatly offended if you discuss, ask me to discuss, or suggest we discuss end-of-life decisions, in effect, changing this wonderful partnership that we have into a political one. If you open the door and allow Earl Blumenauer to enter this room and sit down on the table next to me, it will be the only time you will do so because I will no longer be your patient. And you will no longer be the physician who I’ve trusted and respected for so long. You’ll just be a smarmy business person, making a buck at the expense of my time and your dignity. It will be a sad day, doctor, because in my eyes you will no longer be my trusted friend and physician, you’ll be a whore in a lab coat. And my government will be your pimp.”