Physician Responsibility

Kudos to Douglas Beech, M.D., who reminded us in the November 17 issue that physicians, not HMOs or other administrative entities, are primarily responsible for their signatures on prescriptions, treatment orders, and admissions/discharges.

I see such issues frequently in clinical teaching, consultation, and malpractice cases. When faced with pressure from unreasonable administrative rules or recommendations, we are far better off—clinically, ethically, and even legally—“doing the right thing,” even if one’s order is destined to be overturned by someone else.

Nothing has changed! We know that our clinical relationships and primary duty almost always center on our patients, not third party payers, even when the payers are HMOs, other managed care organizations, indemnity insurers, employers, or public mental health systems.

To those who say they must “go along” to preserve their referral bases or panel positions: Is that what you would teach your children (and tell your conscience) about how you care for patients? It doesn’t play well with juries, I assure you.