hippocratic oath in a free society

[Ruben Zandstra]

I was wondering how some of the current problems that medical professionals are dealing with would look like in a free society.

In the current situation ( at least where we're at) a family doctor, as an entrepreneur, is more or less forced to treat patients that are registered at his/her name. A doctor cannot refuse to have patients assigned to his name, or unregister patients, without going through extreme amounts of bureaucracy / bearing the burdens of proof and accountability. Even after taking such measures, a doctor can be harassed, "warned" by state driven medical organisations etc.  if treatment is refused. There are examples of doctors who after having been physically assaulted by a patient, filed this with the police, did all the paperwork, advised the patient by letter that medical care would have to be sought elsewhere in the future, unregistered the patient, such a patient filed a sucessfull complaint against their doctor  because "the medical professional had not taken all necessary proactive steps to make sure the patient would receive medical care elsewhere".

I am convinced that in a free society many if not most of the assholery that is now quite prevalent among some healthcare patients would simply not exist. But for the sake of argument, let's assume there's a patient like this in Ancapistan. How is it going to be like for him when he requires medical care? How is it going to be like for a doctor who refuses such a patient treatment?

[PatrickC]

How is it going to be like for him when he requires medical care? How is it going to be like for a doctor who refuses such a patient treatment?

I would say doctors will thrive or dive from their reputations. If a doctor refuses to treat a certain individual then he/she will probably need to have a good enough reason why not. Good enough, as in good enough for the majority (if not all) of their patients to accept as reasonable. If it's not considered as reasonable then this doctor will clearly lose patients.

The only reason I can think that the state involves itself in forcing doctors to treat currently is because the medical associations that doctors belong to have effectively created a monopoly for themselves. With this comes an obvious problem with potential shortages, hence the need to force doctors to perform on demand.

[Ruben Zandstra]

There's the issue of being part of a monopoly on healthcare, I agree. The state sold a bunch of promises (guaranteed high income, low competition)  to medical professionals in return for their sovereignty, step by step, and they sold "the right on health care" to the rest of the populace. Now both groups are more or less being held hostage to one another, with a health care industry that has ballooned up to an incredible size, much if which is related to abuse, or is simply a continuation of abuse.

I would say doctors will thrive or dive from their reputations[/font]

And this would probably go for patients aswell.

How would a highly manipulative borderline patient get his cardovascular disease treated, or even diagnosed in a more free society? Simply *not* ?  I guess a fair answer would be that right now it is probably not dealt with so much either, even if there's a social worker stopping by twice a day, a doctor running in and out once a week, police or ambulance is frequently on the doorstep  etc etc. 

[PatrickC]

I would say doctors will thrive or dive from their reputations

And this would probably go for patients aswell.

How would a highly manipulative borderline patient get his cardovascular disease treated, or even diagnosed in a more free society? Simply *not* ?  I guess a fair answer would be that right now it is probably not dealt with so much either, even if there's a social worker stopping by twice a day, a doctor running in and out once a week, police or ambulance is frequently on the doorstep  etc etc.

I'm not particularly familiar with this type of disorder. But I imagine there are a number of ways doctors can control the poor behaviour of some of their patients, without necessarily refusing to treat them. Primarily upping the cost of patient care based on how long they have been using their services and by how much services they require. They could offer discounted premiums like they do for car insurance (no claims bonus), for those that rarely use their services.

However, I can imagine their will be some comprehensive dispute resolution available that will allow doctors to blacklist certain patients who become untenable because of their behaviour. This may well be tempered by strict enforcement of a behaviour code under supervision for when any emergency treatment is required. There should also always be 'A way back' into using health care services in future for those patients that wish to resettle guided by the patients DRO no doubt. I imagine this will be a costly aspect for health care professionals, but considering the potential for loss of reputation I think most doctors will pay for this kind of service, thus bringing the costs down to a minimum.

[Ruben Zandstra]

 

There should also always be 'A way back' into using health care services in future for those patients that wish to resettle guided by the patients DRO no doubt. I imagine this will be a costly aspect for health care professionals, but considering the potential for loss of reputation I think most doctors will pay for this kind of service, thus bringing the costs down to a minimum.

 

I appreciate your thoughts, Xelent. 

I'm not sure I understand what you mean about resettlement being a costly aspect for health care professionals, could you explain? My guess would be that it's going to be costly for the blacklisted patient, not so much for healthcare professionals. I imagine that a DRO ( and the healthcare professional) would demand participation in behavioral therapy or whatever, the presence of sturdy DRO employees at doctor consultations etc. 

[PatrickC]

Yes, I wasn't particularly clear on that. I would guess there will be an initial set up cost for an organisation that might work with doctors to resolve these particularly types of disputes and blacklisting of troublesome patients. They may even bear the brunt or some of the costs of getting third parties to tend to their medical needs under the guidelines I outlined earlier. They may of course work in tandem with a charity that might be prepared to work with these individuals as well. I imagine this working in some similar way to that of a Mutual association or friendly society perhaps. It would be a way of offsetting the cost without being seen as leaving a patient entirely without the possibility of care.

After which, the costs of resettling into the normal health services will fall entirely within the hands of the patient of course. Included in that resettlement could be all the associated costs incurred from above if they so desire.