Internet chat rooms fill with railing plaintiffs. This spring in Connecticut, home of the medical insurance industry, the most powerful appeals law in the country was approved by both legislative houses. The state insurance commissioner will now hear patient appeals when a managed care plan denies payment for physician-recommended treatment. If the medical profession as a body fails to grasp and to fulfill its entire duty in this respect, then will private and public institutions and legislatures step in and take the matter out of the hands of the profession. True to Harris's prophecy, physicians and managed care are being regulated, and fast.
Physicians have enormous discretion in decisions to use medical tests and procedures.
Martin Hickey, chief medical officer of Lovelace Health Systems, is fond of saying that a physician's pen is the most powerful tool he or she has. And economic issues are among the most common ethics problems seen by physicians. A study by Julia Connelly, M.D. in the mid-1980s found that ethics problems affected at least 10 percent of all outpatient encounters. There's little reason to believe that percentage has declined in the years since. Matters of money Coverage.