Consumer-driven health care good for CAM, troubles other doctors

Marcia Angell, MD still 'longs for the days when doctors still advised,' but alas, time moves forward and consumer autonomy now prevails over old medical paternalism.

Or, as a Greek philosopher once said, no-one steps in the same river twice. A Buddhist might chuckle at "impermanence." No matter: medicine is changing, powerfully. Like Digg, Delicious, and our old friend amazon.com, health care now reflects the input of the no longer silent millions, who vote with their payments. Has the pendulum swung too far? Angell thinks so:

Doctors have become vendors and patients consumers operating in a medical marketplace. Patients are now expected to take responsibility for their healthcare decisions, choosing and designing their own treatments, sometimes with little or no direction from their doctors. To be sure, doctors are supposed to present the options, along with the pros and cons of each, but they're not supposed to decide which is best for the patient. If patients ask what they should do, doctors often retreat to generalities: "I've seen some patients do very well with option A."

In the not so good old days, doctors wore white coats and made authoritative pronouncements -- a time when informed consent was a legally enforced exception to physician dominance over health care decisions. But in consumer-drive healthcare, argues Angell:

Patients are sovereign purchasers who choose from a menu of options put before them by their doctors. They search the Internet for information and compare notes with friends to help make their choices. For their part, doctors lean over backward to be neutral.

I find the pendulum metaphor interesting -- the note that we have changed one "sovereign" (the doctor) for another (the patient).

CAM speaks about balance, homeostatis, right relationship. Readjusting the power dynamic may be necessary, in order that both physician and patient enter into what in integrative medicine is known as the therapeutic relationship - the healing relationship.

Angell makes the familiar argument that there is something special about caring for the body -- it is "not like shopping for groceries." Indeed. For that reason, licensing laws ascribed all diagnosis and treatment of disease to medical doctors, made unlicensed medical practice a crime, and granted narrower scope of practice to licensed non-medical practitioners. It took a long time for courts to recognize, again through the principle of informed consent, that the patient has the ultimate right to decide what shall be done with his or her own body. But Angell puts a slight twist on this argument and says that the artful patient should press the MD for a true opinion, pushing past the fear of liability and of being too authoritative. The body is special, she argues, therefore we must take extra care to get it right.

True enough. Abraham is once again smashing the idol gods of old, but when these are replaced with the new deity of consumer choice, will this bring wisdom, harmony, and new models for accurate care, or simply leave us awash in confusion and indecision?

Maybe integrative medicine holds a key in its vision of combining technological, medical expertise with the notion of seeing each person as a unique whole, occupying mental, emotional, spiritual, and environmental spaces of either dis-ease or potential health, as well as physiological states.

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Law Offices of Michael H. Cohen offers general corporate legal services, litigation consultation, and expertise in health law with a unique focus on alternative, complementary, and integrative medical therapies.

Michael H. Cohen is Principal in Law Offices of Michael H. Cohen and also President of the Institute for Integrative and Energy Medicine (also known as the Institute for Health, Ethics, Law, Policy & Society), a forum for exploration of legal, regulatory, ethical, and health policy issues involved in the judicious integration of complementary and alternative medical therapies (such as acupuncture and traditional oriental medicine, chiropractic, massage therapy, herbal medicine) and conventional clinical care. The most recent published book by Michael H. Cohen on health care law, regulation, ethics and policy pertaining to complementary, alternative and integrative medicine and related fields is Healing at the Borderland of Medicine and Religion. This is the fourth book in a series, following Complementary and Alternative Medicine: Legal Boundaries and Regulatory Perspectives (1998), Beyond Complementary Medicine: Legal and Ethical Perspectives on Health Care and Human Evolution (2000), and Future Medicine: Ethical Dilemmas, Regulatory Challenges, and Therapeutic Pathways to Health Care and Healing in Human Transformation (2003).

Health care and corporate lawyer Michael H. Cohen has also been admitted to the Bar of England and Wales as a Solicitor (non-practicing), adding to Bar membership in four U.S. states.
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