Bluffing, Puffing and Spinning in Managed-Care Organizations

Abstract

I argue that because bluffing, puffing, and spinning are features of corporate life, they are likely to characterize the doctor-patient relationship in managed care medicine. I show that managed-care organizations (MCOs) and the physicians who contract with them make liberal use of puffing and spinning. In this way, they create a context in which it is likely that patients will also use deceptive mechanisms. Unfortunately, patients risk their health when they deceive their doctors. Using the warranty theory of truth I argue that although bluffing may be ethical in business because all participants agree to it and business has not warranted truth-telling, it is not ethical in a medical context because physicians and MCOs have warranted truth-telling and the quality of medical care depends on it.

Trust: The Scarcest of Medical Resources

“…At the same time that they enjoy the bene®ts of social capital, they deplete it. MCOs draw on the wealth of social capital in the doctor±patient relationship by either explicitly or implicitly characterizing themselves as patient centered, as opposed to pro®t driven, and by piggybacking on the high-esteem physicians are held in (Illingworth, 2000). Thus they violate principles of fair play.…”

“…Many patients may require high levels of trust in the medical system and in their physicians in order to make the kinds of disclosures that are required for accurate and timely diagnosis and to comply with`doctor's orders' (Mechanic, 1996). They may be motivated to lie even though it is not in their interest (Illingworth, 2000;Wynia et al, 2000). Some patients will lose the therapeutic bene®ts of a high-trust relationship.…”

“…Without trust, information would not be forthcoming. In the absence of trust, the gaming that Morreim identi®es as present between doctor and insurer is likely to extend to the relationship between doctor and patient (Illingworth, 2000;Morreim, 1995;Wynia et al, 2000). The doctor±patient relationship has been a good source of both thick and thin trust.…”

“…They object to managed care and they support increased patient rights (Illingworth, 2000). Studies show that patients complain that their physicians don't spend enough time with them, that they won't make referrals, and that they compromise on the quality of care Gawande et al, 1998).…”

Medicine and Managed Care, Morals and Markets

“…To do otherwise would result in loss of trust by patients. (Illingworth, 2000) For reasons discussed earlier, trust is critically important in the healing relationship because it allows patients to reveal intimate details about their lives, believing that the information will be used for their benefit. It may reduce the patient's anxiety at a time of increased vulnerability and can, in this way, have a therapeutic affect.…”