On the other hand, physicians should not advocate for patients when interventions are only marginally beneficial and an exception to the guidelines is not justified, but should explain to the patient why the intervention is not recommended at this time. Physicians can help ensure that managed care institutions are ethically responsible. It makes little sense to hold physicians to ethical responsibilities without giving attention to the responsibilities of managed care organizations that constrain and influence the actions of individual doctors. If the organizational context is not ethically sound, physicians may be placed in the bind of having ethical and professional responsibilities that are extremely difficult to carry out. Physicians and professional societies can help managed care organizations establish practice guidelines and standards for utilization review.
Physicians can help evaluate published studies critically and provide expert judgments.
Professional organizations like the ACC can play an important role in recommending practice guidelines, particularly as new knowledge about cardiology procedures is published. When developing such guidelines, physicians need to recognize their own self-interest in obtaining greater insurance coverage and compensation for their services. Because of such conflicts of interest, physicians need to adopt procedures to enhance impartiality of deliberations and ensure that guidelines are based on rigorous evidence. Some financial incentives may be too powerful, and some utilization review procedures may be too restrictive, creating an unacceptable risk that appropriate care will be denied. Some organizations may schedule patients so tightly that physicians have no real opportunity to discuss options for care with patients or to serve as patient advocates when coverage for beneficial care is denied.