So we’re admitting this patient to the hospital, or we’re making rounds and we realize that something unethical is going on. Maybe a doc in the community is giving the patient long-running treatments for a “disease” that doesn’t exist, or a nephrologist is continuing to provide dialysis when the acute injury has resolved and the patient’s creatinine is down to 1.5.
You don’t want to come out to a patient you just met and announce that his or her dear and glorious physician is milking the health care system and risking the patient’s health (those IV lines get infected, remember?). You may come up with sneakier ways to do it, like getting a second opinion. That sounds good until the thoroughly brainwashed patient fires the new consultant: “Dr. Miracle said I’ll die without these treatments, and I believe him.”
File a complaint? But you’re just a general internist, FP or pediatrician; who’s gonna believe your word against that of a specialist? Even if your state has a fabulous licensing board, nothing is likely to happen.
So, in the immortal words of Isaac Asimov: Anybody got any ideas?