ON THE COVER
PRACTICING & LIFE MEMBER CATEGORY Winner
Ethical & Moral Consideration IN 21 ST CENTURY MEDICINE
Morris Weiss , MD
I
am a physician . I am a cardiologist . I am old . The only appellation of significance is : a physician .
The two most important issues affecting my medical career are ethical and moral .
Computers have undermined our ability to tell the truth . To get meaningful reimbursement for seeing a patient and fulfilling the computer program requirements , perjury is a preordained requirement . In addition to the chief complaint and the history of present illness , a review of systems and a detailed physical examination with several organ systems are mandated . I receive from consultants a computer of four-to-seven-page printout of essentially worthless data . After this extensive dissertation , the last line is all that is important : “ The patient is stable , see again in six months .” These reports are filled with perjured information .
Recently , my office manager said that the Medicare supervisor working for my employer needed to go over some charts . The Medicare police lady appeared with her portfolio bulging with patients ’ private records . She pulled out one and said “ You charged a five for this visit ( the highest charge for an office visit ), but you never saw the patient .” I dictated a long note and stated this was a conference , not an office visit , between the patient and her daughter that lasted over an hour , about a plan for treatment and prognosis . The police woman said , “ You did not see the patient since there is no chief complaint and history of present illness recorded .” I countered that this was a conference not a regular office visit . She said , “ Make up a chief complaint and HPI .” I responded , “ I will not perjure myself for the sake of a few dollars .”
I asked her to leave my office before I called security to escort her out . Constant vigilance not to perjure ourselves will be difficult ; we must constantly be pushing back a necessary evil .
The second problem is the moral issue . Our parents and grandparents often died in their 50s and 60s of cardiac , infections , diabetic and cancer illnesses , now so effectively treated that 20- 30 more years of longevity has become the norm . How society handles this population is a moral issue .
About 40 years ago , I addressed this problem with a paper on death and dying , introducing the concept of benemortasia ( the good death ). Now more than ever , our octogenarians and nonagenarians need our help and advice .
We learn in our earliest years that religion helps us to overcome the fear of death and to try to understand the nature of the universe . Everyone knows they will die . The real fear of death is not this reality , but how we are going to die .
Will death be quick ? Will death be painless ? Will death be a long illness ? Will death be a dreadful process ?
Now , we have created this new cadre of elderly . Our moral responsibility is to provide benemortasia by not artificially prolonging existence , by carefully considering if more tests , surgery and pills are adding quality to an already long life . And , this is a profound moral question we face every day , and each of us must answer working within a moral framework .
Dr . Weiss practices Cardiovascular Diseases with Medical Center Cardiologists .
JULY 2017 17