Thursday, February 03, 2005

Dr. Bernstein, of Bioethics Discussion Blog, requested, "Are you aware of any issues in medicine or biologic science which are being done right, could be improved or in fact represent totally unethical behavior?" As my introduction above indicates, I review medical records in connection with disability claims.

I see quite a few claims that are supported by attending physicians (AP) who view supporting the claim as "advocating for my patient." After I get a chance to discuss the claim with the AP, she will usually agree with my interpretation of the medical records in terms of specific restrictions and limitations, but sometimes will continue to advocate the patient's desire not to return to work.

However, I don't agree that not returning to work is always the best for the patient. It may be what the patient wants, but not necessarily in the patient's best interests. Frequently, the physical and psychological discipline associated with the workplace is beneficial to the patient.

Since when is it our responsibility to give the patient what they want, in the interest of advocacy, as opposed to standing firm for what is in the patient's best interest? If the patient wants antibiotics, yet we are confident she only has a viral URI, what do we tell her?

I believe a true advocate for the patient recommends and provides what is best for the patient, even if it isn't what the patient wants. We may lose some patients if we do this, but this particular post is about ethics.