Confronting ethical dilemmas in healthcare is a serious issue that has to be addressed now more than ever. The paradox of modern existence lies in the illusion of simplicity. We are told that the faster the more efficient, the newer the better and the easier the wiser. Yet, this appealing narrative creates and conceals negative side effects. “False advertising” and “scam” are now rampant terms, but their connotation remains commercial. We seldom think of these traps as existing within society’s older institutions, like medicine.
The prestigious medical field presents its own paradox. With extensive erudition and training, doctors are often admired for their superior skill and moral high ground. But is their realm truly distinct? What if “faster, newer, and easier” had infiltrated patient care?
In this age of information, digitizing medical documentation is a natural, and desirable phenomenon. Yet, a less desirable aspect of the trend is that doctors find themselves spending less time listening to patients and interacting with them organically. This inherently compromises the quality of care provided, as it reduces opportunity for doctors to discuss symptoms and patient concerns thoroughly. The sense of intimacy a patient used to feel in a doctor’s office is now segued into a tablet.
Technological advancement in medicine also unearths systemic and ethical issues. Since the Affordable Care Act, insurance coverage among Americans is widespread, but bureaucracy is reinforced with electronic medical records. In fact, doctors must overcome the intense scrutiny of insurance companies to obtain payment for their services. For a doctor to be guaranteed payment, he or she must devise a treatment plan tailored to the patient’s coverage. Such treatment plans are not always warranted by illness.
Ironically, the increased scrutiny of treatment plans does not limit the services offered to patients. It has the opposite effect of precipitating overutilization—applying treatments incommensurate with a patient’s illness. Dr. Almeida, the founder and medical director at Miami Vein Center, describes seeing dozens of patients a month who have undergone procedures unwarranted by their condition. The trend, per South Florida’s pioneer of venous surgery, does not reduce itself to innocent medical oversights by the previous treating doctors. These cases are symptomatic of moral decay in the medical field. For Dr. Almeida, the unforeseen consequence of the Affordable Care Act has been to lure doctors into creating elaborate, and lucrative, treatment plans for patients with relatively benign issues.
The systemic hurdles of billing in medicine are only some of many concerns in the field. A deregulation of doctor credentials also plagues modern medicine. In his niche of venous disease, Dr. Almeida has witnessed an influx of poorly trained and sometimes self-credentialed physicians. He describes a shift in 1999, prior to when there were clear delineations within medical practice. Then, only surgeons, who had been trained accordingly, could perform surgeries.
Such clear demarcations between doctors’ scopes of practice have since faded. The advent of minimally invasive procedures has lured many doctors into treating diseases beyond the realm of their expertise with the illusion of simplicity. Those with a superficial understanding of veins and rudimentary training with catheters and ultrasound imaging can now self-credential as experts in venous ablations.
Laser ablations have indeed risen 6000 percent in the last 10 years, showing that a huge number of patients are treated with ablation for issues much more superficial. The aesthetic and medical outcomes are then much worse the initial condition.
Dr. Almeida, a board certified surgeon, desires to educate the public by creating authentic web content that counteract the fallacies of the Internet. He is also an active member of the Vascular Quality Initiative, a network of medical professionals dedicated to improving the quality of vascular heath care. His aim is to preserve the integrity of patient care.