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    Restore “honest” medicine

    The time has come to change complicated healthcare practices and systems that breed dishonesty and disrespect for a noble profession.

    “One of the nation’s largest vendors of electronic health records (EHR) software, eClinicalWorks (ECW), and certain of its employees will pay a total of $155 million to resolve a False Claims Act lawsuit alleging that ECW misrepresented the capabilities of its software, the Justice Department announced. The settlement also resolves allegations that ECW paid kickbacks to certain customers in exchange for promoting its product.” —US Department of Justice, US Attorney’s Office, District of Vermont; May 17, 2017.

    This eClinicalWorks story has led to several conversations among my colleagues regarding the importance of integrity and honesty in medical practice. It seems that our healthcare system is overdue for an integrity/honesty overhaul. Let’s review how we can begin the process of restoration at the practice and healthcare system levels.

    Pediatric care is awesome!

    Pediatric providers are quite familiar with the rewards of our specialty. We form a unique bond with families as we assist parents in raising their children. In sickness and in health, we are just a phone call or an office visit away. This parent-physician-patient relationship is part professional and part friendship, and this is why I really like doing what I do!

    I believe pediatricians are obligated to practice honest and responsible care. We expect no less from our staff and from our patients and their parents as well.

    More: What is 'consent by proxy' in medical care?

    When we treat patients, we involve parents in the decision-making process, and offer our “honest” opinion regarding treatment and diagnostic options. Not surprisingly, when faced with options, parents usually ask me, “If my child were your child, what would you do?” and this frequently leads to a meaningful and often lengthy conversation.

    Pediatricians and parents realize that sometimes there are risks and discomforts associated with healthcare choices. Antibiotics can lead to allergic reactions (rarely), blood work is painful (usually), and costs for every additional test add up quickly (always). So, it often comes down to treating our patients as we would like to be treated ourselves—the Golden Rule as applied to Pediatrics—which, in my humble opinion, should guide every medical decision.

    There are 3 major problems with the state of pediatrics today.

    The problem of respect

    Physicians are not always treated respectfully and honestly by patients, and we are often treated unfairly by insurance companies and hospitals, and sometimes even by physician organizations that we expect to advocate on our behalf.

    Situations such as these are all too common among those practicing in the trenches.

    ·      We pediatricians participate in what most consider one of the noblest of professions, yet there are a few medical providers as well as healthcare organizations (hospitals, insurance companies, vendors) that are sometimes greedy or corrupt.

    ·      Physicians themselves are subject to temptation and lose direction, so we read news stories involving physicians who are accused and eventually convicted for overcharging Medicaid or Medicare.

    ·      We are too familiar with the fact that pharmaceutical companies artificially elevate the price of necessary medications (ie, EpiPens). A change is long overdue, and yes, perhaps it’s time to make some waves!

    Honesty must work both ways

    In the day-to-day practice of clinical pediatrics, we depend on honesty when we interview parents about their children’s symptoms.

    ·      There is nothing wrong when parents admit they didn’t take a temperature, but state the child felt warm to the touch. It is wrong, however, for parents to call to make an appointment and exaggerate symptoms to get booked into an already busy schedule.

    ·      We need to make it expressly clear to our patients that our purpose is to help, not to find fault, and their honesty helps in our triage process. Likewise, our honesty helps prevent the spread of infection between families when we tell them to not bring their child back to daycare until the illness is no longer contagious.

    ·      A parent’s honesty helps us render an accurate diagnosis (such as, “Did you finish the antibiotic I prescribed 2 weeks ago?”). When we err, as we all do, perhaps by prescribing the wrong dose of an antibiotic, or even by misdiagnosing a medical problem, we need to be honest in admitting our mistakes to our patients.

    NEXT: How a flawed system breeds dishonesty

    Andrew J Schuman, MD, FAAP
    Dr Schuman, section editor for Peds v2.0, is clinical assistant professor of Pediatrics, Geisel School of Medicine at Dartmouth, ...


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