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“Physician as Double Agent”: New England Journal of Medicine Slams Wellness Programs

Do you know whether heartburn pills are safe for long-term use?

Adding to the well-deserved woes of the “pry, poke and prod” industry is today’s New England Journal of Medicine, certainly the most influential publication in healthcare. Written from a physician’s perspective (adding to the patient’s and coach’s perspectives we have documented earlier), it details the conflicts of interest created when a patient’s primary care physician has to rat out the patient for not adhering to a treatment plan.

The title of the article, “Physician as Double Agent,” says it all. A typical observation:

Requiring physicians to report their patients’ noncompliance to insurers can put them in a quandary. Doctors’ primary ethical duty is to promote their patients’ health and well-being. When a patient’s health care costs hinge on a physician’s report, refusing to certify the patient’s compliance can inflict meaningful harm. 

The author uses the example of Blue Cross of Michigan, which (in certain violation of the upcoming EEOC rule changes) makes employees get physical exams or lose up to $4000/year…and makes the doctor report noncompliance:

Placing physicians in this reporting role is also potentially devastating to the trust on which a productive doctor–patient relationship is built. For example, an employee in the Healthy Blue Living HMO who has depression can qualify for lower-cost insurance only if he complies with his physician’s treatment plan. Yet many patients discontinue antidepressant medications prematurely, often because they doubt the drugs’ benefits or experience unwanted side effects. When these patients view their physicians as agents of their insurers and know they face penalties for noncompliance, they may be less likely to share these concerns with their doctors. Some may terminate treatment while falsely claiming to comply.

The author also points out the obvious: to what end?  Outcomes-based wellness programs don’t work, so why do them?  There is no upside and therefore no argument in favor of poisoning the doctor-patient relationship. He concludes by admitting any one doctor is powerless against the forces of the insurance industry but:

As a group, doctors can advocate for policies that protect patients, the medical profession, and the relationship between the two. In the absence of compelling evidence that incentive-based wellness programs improve employee health, I would urge physicians to oppose arrangements in which the penalty for poor health is reduced access to health care.

Opposing outcomes-based wellness? Join the crowd.

PS Sorry but this article is behind a paywall.  Presumably it will soon be in the public domain.

In the immortal words of the great philosopher Pat Benatar, hit me with your best shot.

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