In doing more research I found this example of the subtle way that our Colorado Medical Board (CMB) is slowly dehumanizing our medical system and evolving it into a corporate industry.
My source is “The Colorado Medical Board Abolished The Hippocratic Duties” written by Dr. Horiagon MD MOccH October 10th, 2015
He starts his story:
“In the wake of complaints about Colorado physicians involved in occupational medicine and other types of "forensic" practice who violated the Colorado Medical Practice Act Policy 40-3 addressing the doctor-patient relationship, the Colorado Medical Board, without much notice, essentially eliminated the duties embodied in the Hippocratic (and other professional medical oaths) to accommodate corporate interests.”
Then he presents the before and after of CMB 40-3 Policy Statement and I must say it’s creepy the way the thing got artfully watered down. (Green background represents the old policy statement, pink is the revised version.)
Here is the original policy:
40-3 Policy Statement Regarding the Physician/Patient Relationship
Date Issued:
11/13/97
Date(s) Revised:
7/1/10
And here is the new policy:
40-3 Policy Statement Regarding the Provider/Patient
Date Issued: 11/13/97
Date(s) Revised: 7/1/10; 8/20/15
Purpose: To clarify the Colorado Medical Board’s position concerning the physician/patient relationship
Purpose: To clarify the Colorado Medical Board’s definition of, and position concerning the provider/patient relationship
POLICY: The following statement reflects the policy of the Colorado Medical Board regarding the physicians it licenses.
POLICY: The Colorado Medical Board (“Board”) adopts the following policy regarding the provider patient
relationship:
A Colorado physician has both medical-legal and ethical obligations to his or her patients. These are well established in both law and professional tradition.
The prevailing model of medical practice, as it is implemented by some plans, may result in an inappropriate restriction of the physician's ability to practice quality medicine. This may create negative consequences for the public. It is incumbent that physicians take those actions they consider necessary to assure that the procedures in question do not adversely affect the care that they render to their patients
The Board defines “Provider” to include licensees regulated by the Board and the “Provider-Patient
Relationship” as the mutual understanding, between a provider and patient, of the shared responsibility
for the patient’s healthcare. This relationship is established when:
{This sounds like physicians have been reclassified in with RNs, physical therapists, drug counselors and the like.
Why would the Colorado Medical Board disregard the physician’s unique role and duties?}
A. The provider agrees to undertake diagnosis and treatment of the patient, and the patient, or a medical proxy for the patient, agrees to be treated- whether or not there has been an in-person encounter between the patient and the provider; and,
B. The provider:
i. Verifies and authenticates the patient’s identity and
location;
ii. Discloses his or her identity and applicable
credential(s) to the patient; and,
iii. Obtains appropriate informed consent after any
relevant disclosures regarding the delivery models and
treatment methods or limitations, including any
special informed consents regarding the use of
telehealth technologies.
A “Provider-Patient Relationship” has not been established when either the identity of the provider is
unknown to the patient or the identity of the patient is not known to the provider.
{That sounded more like industrial instructions for running chattel through the line, than guidelines for patient caregiver relationships.}
Further, the Board finds the relationship between a provider and a patient is fundamental, and is not to
be constrained or adversely affected by any considerations other than what is best for the patient.
Without regard to whether an act or failure to act is entirely determined by a physician, or is the result of a contractual or other relationship with a health care entity, the relationship between a physician and a patient must be based on trust and must be considered inviolable.
Included among the elements of such a relationship of trust are:
Without regard to whether an act or failure to act is entirely determined by a physician, or is the result of a contractual or other relationship with a health care entity, the relationship between a physician and a patient must be based on trust and must be considered inviolable.
Included among the elements of such a relationship of trust are:
{Here we have a continuity issue.
In the new guidelines CMB goes out of its way to define “Provider” and drops physician, now they are using physician again with a cut and paste from the old guidelines. So what was the point of that exercise?
If nothing else it indicates some sloppy thought processes, but then guess that’s where the lawyers and creative reinterpretation find their wiggle room.}
- Open and honest communication between the physician and patient, including disclosure of all information necessary for the patient to be an informed participant in his or her care.
- Open and honest communication between the physician and patient, including disclosure of all information necessary for the patient to be an informed participant in his or her care.
- Commitment of the physician to be an advocate for the patient and for what is best for the patient, without regard to the physician's personal interests.
- Commitment of the physician to be an advocate for the patient and for what is best for the patient, without regard to the physician's personal interests.
- Provision by the physician of that care which is necessary and appropriate for the condition of the patient and neither more or less.
- Provision by the physician of that care which is necessary and appropriate for the condition of the patient and neither more or less.
- Avoidance of any conflict of interest or inappropriate relationships outside of the therapeutic relationship.
- Avoidance of any conflict of interest or inappropriate relationships outside of the therapeutic relationship.
The relationship between a physician and a patient is fundamental, and is not to be constrained or adversely affected by any considerations other than what is best for the patient. The existence of other considerations, including financial or contractual concerns is and must be secondary to the fundamental relationship.
Any act or failure by a physician that violates the trust upon which the relationship is based may place the physician at risk of being found in violation of the Medical Practice Act.
The existence of other considerations, including financial or contractual concerns is, and must be, secondary to the fundamental relationship.
Prevailing models of medical practice may result in an inappropriate restriction of the provider’s' ability to practice quality medicine, creating negative consequences for the ‘patient. It is the expectation of the Board that providers take those actions they consider necessary to assure that the procedures in question do not adversely affect the care that they render to their patients.
Dr. Horiagon finishes with:
The new policy is not connected to sanctions and eliminates the physician's duty to advocate on behalf of the patient, eliminates the inviolability of trust, and eliminates the need to avoid or act on conflicts of interest.
"Physicians" are now officially "providers".
This paves the way for anything being placed in a physician contract and allows the corporate practice of medicine in anything but name only. Large employers have always enjoyed the absence of prohibitions about the corporate practice of nursing and this has resulted in a competitive advantage for mid-levels in certain fields, e.g. occupational medicine.
https://www.linkedin.com/pulse/colorado-medical-board-abolished-hippocratic-duties-tom?trk=mp-reader-card
Also see the July 23rd 2016 follow up:
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