Case Study 14 : CONFIDENTIALITY AND MINORS
Challenges
A 14-year-old boy came for treatment of psoriatic lesions mostly over the palm and the soles. Upon further investigation, he was diagnosed to have secondary syphilis; this was confirmed by biopsy and serologic exams.
Bothered by this discovery, the dermatologist asked the boy’s mother for permission to speak with him privately. The boy admitted that he contracted the disease from their household help, but asked the doctor not to reveal this to his mother.
Question
Given that a contract binds the patient, doctor and HMO, which side should the doctor support when the HMO’s contractual statement conflicts with the patient’s welfare (as judged by the doctor)?
Solutions
The physician must frequently go beyond legal limits to properly balance responsibilities to the other two parties (patient and HMO).
The physician must always act as the patient’s advocate. For example, when the patient needs tests not covered by the contract, or to stay in the hospital longer than allowed, the doctor has to seek reconsideration from the HMO.
Conversely, the physician should also act as the HMO’s advocate, by avoiding all unnecessary procedures, even those covered by insurance. Unnecessarily exploiting insurance coverage is unfair – this added burden will surely be eventually passed on to other subscribers, resulting in higher premiums and other fees.
HMOs frequently gain the upper hand in negotiations, since they could always employ legal provisions to their advantage, insisting on non-payment for additional procedures. Doctors should organize themselves to protect their interests and those of the patients.
