“Fraud” in Medicine

One bioethicist who would like to see people more frequently denied healthcare that he deems “futile” is up in arms because in “a new study, researchers found that zero physicians providing LDCT had a qualifying shared decision making visit with an evidence based decision aid. Potential harms of screening were not adequately explained, and decision aids were not used.’”

Low Density CT (LDCT) is used to screen for lung cancer, but doctors are supposed to first have a “shared decision making” visit that must include one or more packaged “decision aids.”

First, beware of the latest medical fads known as “shared decision making” and “decision aids.” While this can be a way for you to make a better-informed decision, they are generally used when administrators think people will be less likely to opt for an intervention; in other words, for talking you out of care.

What bothers me is this: The U.S. Preventive Services Task Force has extensive information regarding the requirements for this procedure.  Researchers used OPTION, a special scale developed to measure the quality of these conversations:

“Independent observer ratings of communication behaviors of physicians using the OPTION (Observing Patient Involvement in Decision Making) scale, a validated 12-item measure of SDM (total score, 0-100 points, where 0 indicates no evidence of SDM and 100 indicates evidence of SDM at the highest skill level); time spent discussing LCS during visits; and evidence of decision aid use.”

The 2016 Oregon Death with Dignity Act Data Summary is 16 pages; the USPSTF proposal for LDCT screening guidelines is 46 pages.  Most data points in the DWDA contain an entry for “unknown.”  For example, complications are unknown in 48% of cases since the practice was legalized, whether a healthcare provider was present at the time of ingestion is unknown 50% of cases, and whether a healthcare provider was present at the time of death is unknown in 22 cases.

The bioethicist suggests that the LDCT doctors be sued for fraud, while those who participate in assisted suicide are protected from both criminal and civil liabilities, something otherwise unknown in medicine.

We wouldn’t want someone to get a LDCT lung cancer screening without being thoroughly informed about all their options, would we.