The issues, cases, decisions and situations discussed by Severin indicate that, fortunately in one area and unfortunately in another, the more things change, the more they stay the same. Furthermore, his article raises an important medicolegal policy issue.
With regard to what stays the same, I note that what I learned as a medical student in the late 1960s, and what I then taught my interns when I was a resident and my residents when I was an associate professor of family practice, still is the mainstay of effective clinical medicine: A thorough and thoughtful history and physical examination performed by the attending physician remains fundamental to the timely and proper diagnosis and treatment of patients. An accurate family history, which has been taught to medical students from time immemorial, is still the bedrock of diagnosis of not only the complaining symptoms but also potential hereditary, familial, and genetic conditions.
Short-Sighted View of Insurers
That which also, unfortunately, remains the same is the apparent short-sighted view of the insurance companies. Rather than authorizing and reimbursing indicated prophylactic surgery, it appears that the companies plan to test in every state the question of whether family cancer syndromes and similar conditions constitute "disease" states that are compensable under the various health contracts.
I find it frustrating that the insurance companies remain outside the health care "loop" and prefer to expend their funds on litigation rather than indicated prophylactic care of patients. Moreover, if the indicated surgeries are not completed now, it is clear that the insurance companies will later be paying for much more expensive (and preventable) radical surgeries, chemotherapy, and numerous hospitalizations. Thus, given the large number of family cancer syndromes that have been recently described, the insurers' view is not only medically short-sighted but also not in their own long-term financial interests.
An Important Policy Issue
Finally, the policy matter that affects patients, their families, physicians, and attorneys (for both plaintiffs and insurance carriers) is the following: What responsibility does a physician owe to the family of a patient in whom he or she has diagnosed a familial cancer or other familial condition? It is hoped that the organized medical and legal professions, along with the other members of the health-care industry, such as the insurance carriers, HMOs, and PPOs, will cooperate in formulating proper mechanisms for primary-care physicians to inform nonpatient relatives of their potential for developing genetic-based illness in a speedy, economical, and, hopefully, nonlitigious manner.