Social Responsibility of Physicians Regarding Health Care

I. Introduction

The responsibility of physicians in the United States continues to increase as the country grows and becomes more diverse. Because social structures and religous concepts are so much a part of medicine, physicians must be aware of the responsibilities of social justice and cultural sensitivity. One of the ways that physicians must meet the demands of the increasingly diverse community is to become aware of the need for cultural sensitivity in the treatment of patients. But why is cultural sensitivity important? Cultural sensitivity is important because in order for physicians to respect the autonomy of the patient and to practice not only non-maleficence but beneficence, the physicians must exert energy into becoming culturally aware.

II. Cultural Sensitivity in a Health Care Environment

a) Mission and Autonomy of Patients

Physicians play a crucial role in the service sector of the community, and in light of the Christian physician, the role of server also implies connotations of mission. It is important to state what mission is not, in this context, in order to eleviate any misconceptions. "Mission is not pushing your point down someone's throat. It is not being disrespectful or erasing the culture of the people that you are sent to serve" (Shelly, 3).

If the autonomy of the patient is not protected, the trust between physician and patient is affected. So, the question arises: whose responsibility is it to promote cultural awareness? Is it the responsibility of the physician to research and understand the different cultures that are most dominant in the area? Is it the responsibility of the patient to explicitly state their cultural/religious beliefs verbally or in the form of a living will? Is it the responsibility of the nurses to gain an accurate understanding of the beliefs of their patient and record the history on the chart for the physician? Or, is it the responsibility of the hospital to provide courses in instructing the medical personal in methods on being culturally sensitive. As often occurs in ethical issues, the responsibility for cultural sensitivity falls on the shoulders of all of the above.

As a result of the United States becoming increasingly diversified, it would not be possible, or fair to ask the physicians to be solely responsible for the implementation of cultural sensitivity. To ensure just and accurate cultural sensitivity, there must be a partnership between the physician, patient, nurse, hospital and all medical personal.

II: The Role of Justice in the Health Care Setting:

a) Retributive verses Restorative Justice

Justice is imperative to cultural sensitivity and social responsibility in general. There are two main concepts of justice as outlined by Shenk-Schrock in, "Conciliation Quarterly". Retributive justice focuses on blame and encouragement of competitive and individualistic values. Restorative justice embraces the use of community and encouragement to attain a relationship. Obviously, restorative justice and its effects on cultural sensitivity and social responsibility will be focused on.
So how does justice directly pertain to cultural sensitivity? Once again many factors influence the correlation of justice to cultural sensitivity.

b) Effects of Health Maintanance Organizations

Many of the people that are not receiving health care in the United States are the poor. A large percentage of the poor in the United States are those that are from other cultures. With this injustice in mind, how can a physician use the theory of restorative justice to implement cultural sensitivity? One way of implementing restorative justice would be, specifically for Health Maintenance Organizations, to remove incentives for physicians who join their organization. When fiscal bonuses are present, it is easy for the physician to shift the patients under his/her care from patients using the social services to patients that are part of the HMO.

In order to fully incorporate the theory of Restorative Justice, society needs to move away from the institutionalization of health care. With the emergence of Health Maintenance Organizations patients are increasingly becoming statistical, especially with the fiscal incentives that the HMO's offer. Deborah Smith Parker of San Diego, California shared this poem in Journal of the American Medical Association, entitled "With HMO's---Well, Who Really Knows?.

Employers got nervous with just fee for service,
their medical bills were too high.
So they gave up their voice and physician choice
to give HMO's a try.
But how we now cringe that this rationing binge
has sidetracked good care and health.
Which today is replaced by a shiny new face,
the accumulation of wealth.
What we hope now prevails is a lifting of veils
to reveal the HMO's greed,
To see through the sell and pull of hell
subscribers who are truly in need.

With HMO's---well, who really knows,
since data collection's not done;
Now they are aware the data are there,
it' just a function they shun.
It's hard to take looks at their open books,
there's little they must disclose;
So what really occurred is oddly obscured
and lines pockets for their CEO's.
They limit access while alleging success
and to customers they state
How much has been shaved by the excesses they shaved
and then they raise the rate.

But God save your soul if you've got a bad mole
or are losing your body hair,
Or a cyst pilonidal or you're suicidal
and need a specialists care
If you've a strange rash, then you better have cash
for a skin doc you'll never see;
You'll first be deterred from being referred
for medical necessity.
It takes a magician to get past that physician,
your primary care designee,
Who must be a wizz to manage the biz
and who is called a PCP.

On them you depend, but they must defend
the profit on them is onus
To keep the costs low (as to treatment you go)
so executives share in the bonus.
Now physicians who care feel great despair
that they must now so closely ration,
But if they want work, they should act like clerks
and try to stifle all passions.
If they want to be good, then like Robin Hood
they steal from the lords of risk pools.
It's not treating disease or suffering to ease,
it's the almighty dollar that rules.

Health Maintenance Organizations play a critical role in the institutionalization of medicine. Health Maintenance Organizations, while providing many good services, have also contributed to the decrease in cultural sensitivity by providing physicians with fiscal bonuses if they service the
HMO clients (or the middle to upper-class segment of society).

The effects of cost on a physician's responsibilities affect a number of different facets of the health care system. Not only is the physician/patient relationship affected, but the effect of quality of care verses cost of care also becomes an issue.

"Increasing pressures for cost containment and health care reform suggest that the next decade may bring a requirement for societal prioritization of health care services. Theses decisions may require trade-offs between types of health care services available based on their effectiveness, their efficiency, and the capacity of a particular population to benefit from their use. Medical care services and population based public health initiatives sharing common coffers will need to be assessed with respect to these characteristics" (Gold, 175-176).

Inevitably, the existing health care system will need to be reconstructed because currently there is not enough monetary resources to support the procedures and technologies being used.
As the health care system is under construction, will only the upper and middle classes benefit? The necessity for cultural sensitivity now becomes the much broader category of societal responsibility.
How could cost cutting and the shift to the institutionalized medicine of HMO's affect the physician/patient relationship?

c) Effects of a Regular Doctor on Patient Care

It has been found that "persons with a regular doctor had better access to primary care than those with a regular site, but no regular doctor" (Lambrew, 138). In order to increase the availability of all persons to adequate health care and to be socially responsible, "the reality is that cost has to be dealt with. For example, based on projections put forth by federal analysts, Peterson suggests that if program operations continue as currently, by the year 2030, there will be a combined cash deficit of $1.7 trillion for Medicare Hospital Insurance and Social Security" (Smith, 1180). The health care dilemma has become a problem for us all and it is important to be informed about the solutions in order to allow voices from all different social classes and cultural backgrounds be heard.

It is necessary when discussing possible solutions to the health care dilemma that an objective comparability between the studies is sustained. "It is compatible with traditional principle that decisions affecting people with differing interests are more likely to be fair if they are made by those who will not gain or lose by them" (Russell, 1174). In the situation of the health care industry, it is difficult to have a party make a decision in which they would not be affected. Therefore, it is extremely important to have access to studies on cost-effective analysis and "as the number of cost-effectiveness analysis being published with potential use for clinical and policy decisions seems to be increasing, having a working knowledge of such analysis is time well spent" (Smith, 1180).

The necessity for cost - effective analysis is evident, but the question remains, what is a Christian physicians response to the issues, and should it be any different than any socially responsible physician? Much of what Christ called Christians to do was to be socially responsible and culturally aware, in essence he called Christians to serve each other. Physicians serve the community whether or not they label themselves as Christians. Never the less, it is important that the need for social responsibility is not covered in the guise of social service.

IV. Conclusion

When studying the issues of social responsibility (which include both social justice and cultural sensitivity) in the context of health care, cost - effective analysis is a large component. It is important for physicians to view cost - effective analysis through the eyes of social responsibility if the voices of people from other cultures and the poor are to be heard.

Works Cited

Gold, Marthe et al. "Assesing the Health of the Nation." Medical Care. 34 (1996):152.

Lambrew, Jeanne M. et al. "The Effects of Having a Regular Doctor on Access to Primary Care." Medical Care 34 (1996): 152.

Russell, Louise et al. "The Role of Cost-Effectiveness Analysis in Health and Medicine." Journal of the American Medical Association 276 (1996): 1172-1176.

Shelly, Judith Allen. "Mission Impossible." Journal of Christian Nursing 13 (1996):1176.

Shenk-Schrock, Carolyn. "Thoughts from a VORP Guru." Conciliation Quarterly 15 (1996): 4-5.

Social Responsibility of Physicians Regarding Health Care

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