When patients visit their doctor, their experiences may be fairly consistent: a verbal consultation, a physical exam, perhaps some lab work or diagnostic imaging. Despite these similarities, each treatment decision we make as physicians is unique. It is based on important but variable considerations, including our patient’s individual medical needs, the treatment options available, and our training and clinical experiences.
One consideration that does not belong in this treatment paradigm is the impact of outside influences from a patient’s boss or from politicians. Unfortunately, these outside influences are increasingly getting in the way of the patient-provider relationship. It is time for this to stop.
One recent example is the Supreme Court’s ruling in the Hobby Lobby case — a blow to the practice of medicine. The decision gives a green light to employers to insert themselves into our exam rooms, where the boss picks and chooses which types of medical services our patients are eligible for. In this case, it allows a for-profit company to exclude types of birth control from its employees’ insurance coverage, regardless of whether that birth control is the best option for that woman.
This interferes in many ways. It limits the treatment options — in this case, contraceptives — we can consider for our patients. This is important. For example, a woman who is unable to take or tolerate oral hormone therapy may be well-suited to receive an intrauterine device (IUD), which is also the most effective reversible contraceptive available. But if her employer has an objection to the IUD, out-of-pocket costs of nearly $1,000 could place this device out of her financial reach.
From a medical standpoint, this is unacceptable. We must send a clear message that health care decisions should be between a patient and his or her provider, and should not be impacted by the whims of an employer. And we must do it now.
This doesn’t just matter for the women who work for the Hobby Lobby company. It matters for all women, and for all physicians, because the potential scope of this case could be debilitating across medical specialties.
• First, the decision allowing employers to carve out essential medical services from employees’ benefits package is not limited to the four forms of birth control to which Hobby Lobby’s owners objected. The ruling sanctions insurance exclusions forany
form of birth control, including refusal to cover all FDA-approved methods of contraception should a corporation’s owners so choose.
Just last month, a grocery store chain in Ohio won an exemption against providing any contraceptive coverage to its employees, based on the owners’ religious beliefs. With dozens of similar cases being reviewed right now and more to likely follow suit — the impact on American women will only grow.
• Second, there is no legal retaining wall around the decision that confines it to contraception. Nothing stops the exact same reasoning from extending to other services some business owners may find objectionable: blood transfusions, organ transplants, or HIV treatment.
Each year, nearly 30,000 medical school graduates enter residencies and begin caring for patients. Additionally, there are more than 39,000 ob-gyns practicing nationally. Those of us who have chosen to provide primary and reproductive health care to women and girls in the fields of internal medicine, family medicine, pediatrics, and obstetrics and gynecology will feel the most immediate impact of singling out contraception for coverage exclusions.
But, our colleagues in specialities from cardiology to nephrology will feel the ripple effects, too.
Because a patient’s overall health is affected by her ability to time, space, and prevent pregnancies, the consequences of reduced access to the most effective forms of contraception will manifest throughout health care.
At a fundamental level, our ability to practice medicine is threatened by the intrusion of unwelcome third parties into the health care decision-making process. Neither patients nor health care providers — indeed, not the health care system as a whole — can tolerate the singling out of essential services for second-class status.
The exam room is a private space. We need to keep it that way.