Profit over patients, erosion of physician autonomy, and RCAW update

October 22, 2015

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our health care system toward the right care for all patients.

Join the conversation: Post your comments in our section at the bottom of this page.




Scarred by a Trusted Doctor…the headline says it all. Sunday’s New York Times featured the story of a popular Indiana cardiologist, Arvind Gandhi, MD, under fire after hundreds of his patients filed lawsuits claiming he had performed unnecessary procedures on them—some undergoing multiple operations. At least one of Gandhi’s hospital colleagues, Mark Dixon, MD, had complained to administrators, concerned that Gandhi was not qualified to implant defibrillators, which he had been doing. But Dixon was “shut down” by administrators. “The response to me was, said Dixon, ‘I understand your concern but we have a very large producer here who wants the privilege.’” Gandhi and his two partners received millions in Medicare payments in 2012, making them the most reimbursed cardiologists in the state. Yet some in medicine are not surprised by such abuse. “We are still a fee-for-service system,” said Steven Nissen, MD, chief of cardiovascular medicine at Cleveland Clinic. “And that creates, in my view, misaligned incentives among some physicians to do more procedures and among some institutions, particularly in areas where there is not tight medical supervision, to turn a blind eye and enjoy the high revenue stream.” While personal ethics is at the core of these events, so too is a system where self-policing by physicians is often in direct conflict with incentive, wide and permissive medical guidelines, and a paucity of informed patient decision-making all create a perfect storm of failure.


Erosion of physician autonomy is hardly a new topic, but a report from four nonprofits, covered by The Atlantic, describes an emerging trend of legislators dictating what doctors can tell or ask patients. Three areas are addressed in the report: toxic exposures (fracking), reproductive health (abortion) and gun safety. Fracking studies have been linked to health risks, and in order for physicians in some states to learn what chemicals are used in fracking wells, they are required to sign confidentiality agreements with fracking companies, preventing them from discussing chemicals with other physicians and patients. Twelve states require providers to tell patients that their fetuses can feel pain, even though no such evidence exists; that the procedure will jeopardize future fertility; or that it is linked to breast cancer (as if there weren’t enough contradictory information around breast cancer). The courts and legislatures intrude further into the clinic when the topic is gun violence. In Florida, doctors cannot legally ask patients about guns in the home, or explain how to store them safely. Providers who violate orders may face professional, civil or criminal sanctions. More than 15 million people live within a mile of a fracking well; 30 percent of U.S. women will have an abortion by age 45 and more than 100,000 people will suffer gunshot wounds in a year. These laws affect a lot of Americans.


RightCare Action Week continues through Saturday, and there is still time to carry out an activity to show your support for better health care delivery. So many of you have taken the time to tell us about the actions you have been taking—everything from submitting your comments via our photo campaign, to conducting RightCare Rounds in your institutions, to preparing for a StorySlam. Tomorrow we will host a webinar, titled Stories from RightCare Action Week. We hope you join us at noon ET. For registration information, please see the announcement above. In the coming weeks, we will be sharing a summary of RightCare Action Week activities, conducted throughout the nation, so that you can learn how your peers and colleagues marked the event; we hope you’ll continue demonstrating how much better health care can and should be. For now, learn more from some posts herehere and here.




  • Tomorrow the Lown Institute will be hosting a national event called “Stories From RightCare Action Week” via webinar. Join us to hear stories from Shannon Brownlee, Lown Institute Senior Vice President, and RightCare Action Week captains, and to share your story! The webinar will take place tomorrow, Friday 10/23 12-1pm. Register in advance here.


  • There is still time left to submit your abstract!  The Lown Institute’s 4th Annual Conference, with a special pre-conference academic research day, will take place April 15-17, 2016 at the JW Marriott Chicago. We are accepting abstracts for the inaugural academic research day, April 15. In particular, we are accepting abstracts for research that enhances understanding of aspects of right care. Deadline for abstract submissions is November 15, 2015. For submission information, click here. Watch for more conference details coming soon.


  • Registration remains open.  A regional RightCare Alliance meeting will be held in conjunction with the 2015 Family Medicine Education Consortium’s The Best Care Possible: The Right Care–Right Now–Getting Involved for Better Health, on Thursday, October 29, 8:30 am-5 pm at the DoubleTree by Hilton and CoCo Key WaterPark Boston North Shore, in Danvers, MA. Meeting leaders include Alan Roth, DO, chair, Department of Family Medicine, Jamaica Hospital Medical Center; Vikas Saini, MD, president of the Lown Institute and Shannon Brownlee, MSc, senior vice president of the Lown Institute. The event is targeted to health care professionals, policy makers, administrators and staff interested in improving health care delivery and health profession education systems. Learn more and register.




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RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.