The ideal physician

With everyone these days trying to redefine exactly what a doctor does (and is), I thought it was time to set the record straight. The following is my idea of what an ideal physician should do and be.

• To the best of my ability, to acquire and use my best knowledge, skills and judgment for each patient
• To try to learn as much as I can about the workings of the human body and about the diseases, injuries and other conditions that remove people from ideal health
• To try to learn as much as I can about my patient, by history, examination and diagnostic testing, to discover what maladies the patient may have.
• To try to predict, to prophesize the patient's future, based upon the expected natural history of his condition and communicate this to the patient.
• To try to predict or prophesize if there is any risk to others from the patient's condition and to work to reduce or eliminate that risk
• To intervene or advise intervention only if I can produce a better outcome than the expected natural history. Of the options available, to pick the one that has the best chance of success (greatest benefit or greatest benefit to risk ratio)
• To try to prevent, cure, or reduce the impact of the malady upon the patient, to the best of my ability, knowledge and judgment.
• To communicate effectively with the patient and with other members of the patient's health care team, including caregivers if appropriate.
• To protect the privacy of my patient, but not to withhold secrets that might lead to the harm of others.
• When appropriate, to refer the patient to others who might be better able to help.
• To direct the patient to find another physician when the doctor-patient relationship becomes irrepairably damaged.
• To try to prevent others from using the patient's illness to harm our patient based upon their own malice, avarice, retribution or other moral vices/ethical wrongs.

I do not see a role for a physician as keeper of the coffers, overseer of social justice, executioner, or legal counselor. These must be taken into account, but not by physicians. Our duty must be only to the patient and to those directly impacted by the patient.

If I can predict an impending terminal state, it becomes my duty to communicate this to the patient or his representative and must work with the patient to achieve the desired goals, providing that goal is not based upon a moral vice or an ethical wrong.

If I determine that a course of treatment is best for a patient, that patient has in good conscience purchased a health insurance policy, and the insurance company refuses to pay for the treatment, it becomes my duty to fight against the apparent avarice of the insurance company for my patient's benefit.

If I determine that a course of treatment is best for a patient and the patient does not want to pay for it or can't pay for it, I may recommend a less ideal treatment that is within the patient's budget. It is not my duty to make sure that every patient can afford every treatment. This is the job of those who insure patients, patients to be productive members of society, and social organizations to provide safety nets for those who are valued for their existence and not their current contributions to society.

My personal opinion is based upon the concept of free will. It is that those who work, those who have worked and are now retired, those who raise children, those who are too young to work, and those who are unable to work all deserve the best care we have. Those who choose not to work and those who have seriously violated our laws are entitled to whatever they can afford and whatever any private social organization wants to pay for. Those who are not members of our society (ie, illegally in the US) are entitled to emergency care and appropriate transportation back to their country of origin for further care. I believe that no one should prevent a patient from obtaining whatever care is appropriate for him that he can afford, even if it means that he will get a better care (more effective, better effectiveness/risk ratio) than the average person can afford.