Monday, April 14, 2014

Professional Independence

Professional independence has long been a strong element of the culture of health care generally and of the medical profession in particular.  “Following doctor’s orders” was something good patients did and nobody wanted to be accused of “interfering in the practice of medicine.”

That now seems to be in a state of demise. 

The April 8 issue of The Boston Globe carried an article about cutbacks in painkiller prescriptions by Massachusetts Blue Cross Blue Shield.  The key sentence reads “Faced with concerns about a rise in opiate abuse, Blue Cross implemented changes in July 2013 that have reduced prescriptions by 20 percent for common opioids such as Percocet and 50 percent for longer-lasting drugs such as Oxycontin….”  The changes were limits on the number of days’ supply per prescription and the number of refills eligible for payment.  Prior authorization by Blue Cross was also required in some cases.

As I read through the article my thought was that either some bad medicine was being practiced or Blue Cross was interfering in doctor business.  If the former, somebody would “view with alarm.”  If the latter, somebody representing the profession would complain.

Neither turned out to be the case.  Instead Dr. Raymond Dunlap, president of the Massachusetts Medical Society was reported as saying that “Blue Cross is heading in the right direction.”

It looks as if the day is coming when the professional independence of medicine will be a thing of the past.  Doctors who wonder how that happened need only look in the mirror.

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