The Founding Fathers did not include medical treatment in their famous trio of life, liberty and the pursuit of happiness when they spelled out our inalienable rights. Yet how can any citizen run with the Constitution's mandate when he or she feels sick? Surely there is a right to medical treatment in the spirit if not the letter of the law.
Like many statements about rights, this one has a long trail of difficult questions behind it, most of them dealing with how to translate a right in theory into a functioning reality. For although everyone may have a right to medical treatment, not everyone is getting it.
Confounding the translation is the lack of agreement in society about the kind and quality of medical care that should be guaranteed to everyone or about the most effective method of delivery, never mind the intimidating question of how to pay the ever-growing national bill for health care.
The medical profession certainly bears a major responsibility for addressing these issues, but patients also have obligations as well as rights. Only combined and concerted efforts by both doctors and patients can achieve some answers.
The right to medical treatment, most would agree, does not include frills such as the currently fashionable gourment foods served in some hospitals, nor does it entitle everyone to a nose job upon demand. It does include whatever is necessary for the preservation of life and limb, from nose jobs for the nose-injured to kidney jobs for the kidney-diseased. Providing this kind of basic, comprehensive medical care is a very tall and costly order by itself without adding various luxuries and self-improvement therapies to the list.
Patients also have a right to expect that physicians keep abreast of medical advances, despite the regularity with which explosions of knowledge have occurred in recent years, and that the medical profession investigate when there are signs that a physicians's skills have deteriorated. We have been learning to do these things better -- physicians are required in some states to take continuing education credits and we have some mechanisms for peer review in place -- but we still have a way to go.
However well-qualified your physicians are, the right to medical care cannot be meaningful if it is not available when you need it. I do not mean that patients have the right to require a physician's personal attention at 3 a.m. when they are suffering from nothing worse than the sniffles. But people should not have to go to an emergency room for non-emergency ills because they cannot find a physician who will see them after business hours.
Such limited availability was not always the case. When I started to practice, the office was open during evening hours and on Saturdays as well. The patient who needed routine care -- his hypertension checked, for instance -- was not torn between taking time off from work or going to an emergency room on the weekend.
Office hours that take into account the patients' lives are beginning to return, but unfortunately, the change is being brought about by market pressures and competition, not the new dedication of many physicians. I confess that I do not much sympathize with the grumbling of my colleagues on this issue, particularly in group practices where office hours for one or two evenings a week cannot be very difficult to arrange. Sicknesses, after all, do not keep bankers' hours.
The problem of providing medical treatment for the needy is immensely complicated, and I do not propose to answer it here. However, I would like to suggest that physicians, by looking back toward older traditions of medical practice, could be guided toward making one step in the direction of a solution.
When I began practicing medicine, everybody "did" free clinic. That is, we all contributed time and services without charge for those unable to pay. It was the responsible thing to do; it was necessary; it was humane; and who else could do it, anyhow?
I like to call this contribution of services a form of tithing, and I suggest that this traditional kind of contribution be revived by the medical profession. It should be a recognized and expected but voluntary part of every physicians's professional duties. Suppose we each volunteered a mere hour a week or even just 40 hours a year in medical services. Suppose then that we had 400,000 or 500,000 physicians, all of them putting in 40 hours a year for the needy -- now that would make a difference!
Speaking of standards of humanity brings me to the final element required by the right to medical treatment: everyone has a right to receive treatment delivered in a courteous and considerate manner. The tone of the patient-doctor relationship is somewhere near the center of all treatment.
Something goes drastically wrong in that relationship when there are always long waits for an appointment with the doctor, when office hours are inconvenient, when the patient is bustled in-and-out as if there is barely time to see him, and when he is greeted by an abrupt or haughty physician. That patient is apt to understand all these things to mean that the doctor is doing him a favor rather than rendering a timely professional service. This is not the way to inspire trust, frankness and respect.
Something equally undesirable happens when patients make inordinate demands on the doctor's time and good nature, when they force him to practice defensive medicine to ensure against litigation, and they frustrate every attempt to maintain their health by refusing to comply with the physician's prescriptions.
Medical practice works as a partnership, then, with rights and responsibilities on both sides, or it does not work well. In that sense, mutual respect by doctor and patient is downright therapeutic.
Dr. Nicholas J. Pisacano is the executive director of the American Board of Family Practice.