Blog: A question of medical independence

Just in time for the Republican and Democratic presidential conventions, the American College of Physicians has released a position paper telling the people who keep saying they don't want politicians to get between patients and their doctors to stop placing themselves between patients and their doctors.

"Some recent laws and proposed legislation appear to inappropriately infringe on clinical medical practice and patient-physician relationships, crossing traditional boundaries and intruding into the realm of medical professionalism," Dr. David Bronson, president of the ACP, said in a news release.

The ACP spelled out its stance in a 12-page Statement of Principles on the Role of Governments in Regulating the Patient-Physician Relationship (PDF). The statement noted that of particular concern were laws and regulations "that require physicians to provide care not supported by evidence-based guidelines and/or not individualized to the needs of the specific patient."

Approaching the subject politely, the paper begins by stating that "it may be difficult to distinguish between mandates that interfere with clinical practice versus those that promote good public health," but it goes on to basically say that unless you have scientific evidence supporting your position, don't tell us what to say and don't tell us what to do.

And it's about time someone said it.

The paper cites a Florida law prohibiting doctors from asking gun safety-related questions and a Pennsylvania law regulating what physicians must do while trying to diagnose whether a patient's symptoms are related to the "fracking" natural gas extraction process.

"Even laws and regulations that mandate a test, procedure, treatment or provision of specific types of health information or counseling to the patient, when generally consistent with the standard of care and intended to provide benefit to the patient, should be approached cautiously," the ACP states. "Mandated care may also interfere with the patient-physician relationship and divert clinical time from more-immediate clinical concerns."

Other statutes cited by the group include laws or proposed legislation dealing with abortion, do-not-resuscitate orders, mammograms and vaccinations.

The paper also addresses the issue of whether political inaction will cause a regulated standard of care to become "set in concrete" even as new medical knowledge renders it inappropriate or obsolete.

The ACP asks lawmakers to consider several questions before passing any law that tells doctors what to do. Among the questions is this one: "Is the proposed law or regulation necessary to achieve public health objectives that directly affect the health of the individual patient, as well as population health, as supported by scientific evidence, and if so, is there any other reasonable way to achieve the same objectives?"

It's really not too much to ask.

Follow Andis Robeznieks on Twitter: @MHARobeznieks.



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