Also, this area can raise more questions when a rheumatologist is rushed for time. Who should get more time for education? Should everyone get an equal amount of time? What about patients who need help from family members to absorb information or older patients who have more trouble understanding certain concepts? Easy answers to these questions don’t always exist.
Treatment Access
Access to treatment is another ethical concern, particularly with the costly medications within rheumatology.
“It may be that the cost will be incurred by the patient, or a patient’s lack of insurance or lack of access, and it may be a third party weighing in on the best next step and having to advocate for a patient while considering the third party’s interest and considering the cost to the patient, insurer and the health system as a whole,” Dr. Weselman said.
A guiding principle for rheumatologists in this situation is to think about the patient’s preferences and how to help them achieve a reasonable quality of life—and then advocating for a treatment to help them reach that best possible quality of life.
“Sometimes that [approach] means that going with a formulary will work and maybe we can work with that. Sometimes it means that we really need to get involved, and we need to contact the insurance company and write a letter or speak to a medical director,” she said. It also may mean helping the patient find financial assistance programs.
“It’s also making sure that if we think a treatment is best that we really are choosing it because it’s best for the patient and not best for us in any other way based on our relationships with companies,” Dr. Weselman said.
Dr. Hausmann pointed out the conflict that may arise between a physician believing a certain drug will maximally help a patient and an insurer that may put up barriers against it. Insurance companies may have their sights set on what’s best for the population vs. the individual sitting in front of the physician.
“I don’t think it necessarily means that everybody else is unethical, but I do think that having a third party involved in the physician–patient relationship does present unique ethical challenges,” Dr. Weselman said.
Conflicts of Interests
Another common ethical area within rheumatology and medicine in general is managing conflicts of interest between physicians and pharmaceutical companies. Dr. Hausmann pondered whether rheumatologists should have those types of relationships with the companies.
