Viewpoint: Honesty in Healthcare Part 2: The Need for Courage

"This is when another virtue of courage is needed, and it starts with self-honesty in recognizing when we are part of dishonesty because of employment, business interests and law."

Honesty is the responsibility of individuals.

Last month, I started discussing the need for more honesty in healthcare. I included the story of my experience receiving a dishonest “good faith estimate” for the price of a medical test. Individuals participated in this dishonesty. Policy and law will never replace virtue and character, although some people attempt to design such policy. What we see, though, are many policies, laws, and corporate practices that discourage honesty. This is when another virtue of courage is needed, and it starts with self-honesty in recognizing when we are part of dishonesty because of employment, business interests and law. It starts with recognition of our own rationalizations. 

An example of a policy that discourages honesty:

News of this large observational study in 2019 on hospital readmission for heart failure should have been a bombshell, sparking widespread outrage amongst Medicare beneficiaries and the general public, although I doubt that most people know of it. It revealed that hidden financial manipulations by Medicare can increase mortality (bureaucratic rules can get people killed). Of course, I am aware that observational studies do not prove causation, but common sense does give us a conclusion here, and it is that a policy change caused a loss of life. Ordinarily, Institutional Review Boards must review and approve any medical research done on human beings before implementation, and patients must give informed consent to be enrolled in a study. They have the right to refuse to participate. However, I am not aware of this being done for experimentation on patients by way of changes in payment policies. If someone knows otherwise, I hope they will contact me. For hospitals that got publicly shamed and financially penalized for readmitting patients who needed it, I am glad those hospitals did the right thing despite the punishment. Here is the report of the study, and the key points are summarized at the beginning.

It’s hard to imagine that physicians who compromised their judgment about the care of sick patients could admit to it, even to themselves; it’s too awful. 

An example of both honesty and courage by a physician: 

Many people in the United States think we should adopt a Canadian-style health care system, but Canada also has problems with its healthcare (some are different problems). I have heard it is not popular for Canadians to criticize their system. While I acknowledge big problems in the United States, I want more freedom and less top-down control of healthcare and I would resist efforts to be forced into a Canadian-style system. The author of this article, an experienced and reputable Canadian physician in Ontario, went public in 2017 with her observation that they were not providing good care in her emergency department. She stopped blunting her opinions, stopped making excuses to patients and began openly agreeing with them when they were not getting good care. This is an unusual thing for a physician to do, but patients deserve honesty and confirmation when their concerns are valid. You also can’t begin to fix a problem if you don’t acknowledge it. 

What else? What can we do?

In the next article in this series, there will be more examples of the need for more honesty in healthcare, with each example illustrating a different point. I suggest that customers/patients seek honesty as best they can, along with clinical excellence. For anyone involved in healthcare in any way, no matter how hard they work or what sacrifices they’ve made, I suggest that much more honesty is needed, in addition to blaming bad systems. This is also something that is immediately possible. 

Healthcare Viewpoints is a monthly series featuring original columns from Montana healthcare leaders focused on addressing the challenges presented by our broken healthcare system. The opinions of guest authors do not necessarily represent the policy positions of the Frontier Institute.