Mandating bad medicine
There is a trend across the country that deeply concerns us and our fellow health-care advocates and providers: political intrusion on exam rooms.
Pennsylvania and many other states have considered or enacted laws that mandate bad medicine, undermining the relationships between patients and health-care providers. These laws concern a range of issues, including women's health, gun safety, environmental hazards, and more.
One of these laws forbids doctors from telling patients which by-products of natural-gas extraction may be making them or their children sick. Others prohibit physicians from discussing whether a gun in a patient's home might be within reach of a small child. Still others require doctors to subject women seeking abortions to unnecessary medical tests or inaccurate information.
All of this legislation attempts to force health-care providers to choose between the law and their ethical obligation to provide the best possible care.
In 2012, five national medical groups sounded the alarm on legislative interference in the patient-provider relationship in an article published in the New England Journal of Medicine, writing that "legislators in the United States have been overstepping the proper limits of their role in the health care of Americans to dictate the nature and content of patients' interactions with their physicians." They spoke out because these laws override the medical judgment of doctors and other trained health-care providers, disregarding the needs and circumstances facing patients.
The legislative interference comes at a time when we are working hard to improve the quality of care and make it more patient-and family-centered. This contrast was noted in a new report from the National Partnership for Women & Families, "Bad Medicine: How a Political Agenda is Undermining Women's Health Care," which examines abortion restrictions that are contrary to medical standards and efforts to improve care.
Pennsylvania has seen its share of examples of this phenomenon. The bad-medicine mandates on the books here include a mandate that care providers offer women irrelevant and unnecessary information designed to discourage them from seeking an abortion. Another prohibits health-care providers from disclosing the chemicals used in natural-gas extraction to their patients, even if they believe those chemicals made them ill.
Interference like this has to stop, and there is a chance to make that happen here in Pennsylvania, where state legislators are launching an effort to prevent such bad-medicine laws. Legislation to protect the patient-provider relationship, the Patient Trust Act, was recently introduced by Sen. Mike Stack (D., Phila.) as part of the Pennsylvania Women's Health Agenda; it's expected to be introduced in the House this week by Rep. Dan Frankel (D., Allegheny). It would help ensure that health-care providers are not required to give their patients information that is medically inaccurate or, conversely, prohibited from giving them information that is appropriate and accurate. It would also help ensure that providers are not required to deliver care that is inconsistent with evidence-based medical standards, or prevented from delivering care that adheres to such standards. Such protections are sorely needed, and this bill deserves the support of the legislature and the public.
Government certainly has an important role to play in regulating the health-care system. The federal and state governments provide health coverage for nearly half the U.S. population through Medicare, Medicaid, the Children's Health Insurance Program, and the Department of Veterans Affairs. We need government to approve drugs and medical devices that are safe and effective, assure that drugs and devices are manufactured properly, fund medical research, support the education and training of the health-care workforce, protect public health, and much more.
The Patient Trust Act makes a strong statement about the difference between appropriate regulation and out-of-bounds political interference. It would be an important step toward protecting the patient-provider relationship and ensuring that politics don't trump high-quality health care.
Dr. Charles Cutler is a past chairman of the Board of Regents of the American College of Physicians and a practicing internist in Norristown. email@example.com