ON THE COVER
PRACTICING & LIFE MEMBER CATEGORY Winner
Ethical & Moral Consideration IN 21 ST CENTURY MEDICINE
Morris Weiss, MD
I
am a physician. I am a cardiologist. I am old. The only appellation of significance is: a physician.
The two most important issues affecting my medical career are ethical and moral.
Computers have undermined our ability to tell the truth. To get meaningful reimbursement for seeing a patient and fulfilling the computer program requirements, perjury is a preordained requirement. In addition to the chief complaint and the history of present illness, a review of systems and a detailed physical examination with several organ systems are mandated. I receive from consultants a computer of four-to-seven-page printout of essentially worthless data. After this extensive dissertation, the last line is all that is important:“ The patient is stable, see again in six months.” These reports are filled with perjured information.
Recently, my office manager said that the Medicare supervisor working for my employer needed to go over some charts. The Medicare police lady appeared with her portfolio bulging with patients’ private records. She pulled out one and said“ You charged a five for this visit( the highest charge for an office visit), but you never saw the patient.” I dictated a long note and stated this was a conference, not an office visit, between the patient and her daughter that lasted over an hour, about a plan for treatment and prognosis. The police woman said,“ You did not see the patient since there is no chief complaint and history of present illness recorded.” I countered that this was a conference not a regular office visit. She said,“ Make up a chief complaint and HPI.” I responded,“ I will not perjure myself for the sake of a few dollars.”
I asked her to leave my office before I called security to escort her out. Constant vigilance not to perjure ourselves will be difficult; we must constantly be pushing back a necessary evil.
The second problem is the moral issue. Our parents and grandparents often died in their 50s and 60s of cardiac, infections, diabetic and cancer illnesses, now so effectively treated that 20- 30 more years of longevity has become the norm. How society handles this population is a moral issue.
About 40 years ago, I addressed this problem with a paper on death and dying, introducing the concept of benemortasia( the good death). Now more than ever, our octogenarians and nonagenarians need our help and advice.
We learn in our earliest years that religion helps us to overcome the fear of death and to try to understand the nature of the universe. Everyone knows they will die. The real fear of death is not this reality, but how we are going to die.
Will death be quick? Will death be painless? Will death be a long illness? Will death be a dreadful process?
Now, we have created this new cadre of elderly. Our moral responsibility is to provide benemortasia by not artificially prolonging existence, by carefully considering if more tests, surgery and pills are adding quality to an already long life. And, this is a profound moral question we face every day, and each of us must answer working within a moral framework.
Dr. Weiss practices Cardiovascular Diseases with Medical Center Cardiologists.
JULY 2017 17