Refusing to Treat Noncompliant Patients is Bad Medicine

Abstract

Government health programs and private payors have adopted various reforms that fundamentally transform the physician-patient relationship. Public reporting on how well physicians perform on various quality and cost metrics, as well as payment reforms that link physicians’ reimbursements to their performance on these metrics, incentivize physicians to improve the quality and efficiency of care they provide to patients. Less appreciated, however, is that these reforms also create strong incentives for physicians to reject patients who do not abide by their physician’s medical opinion, including recommendations that the patient adopt healthier behaviors. These noncompliant patients increasingly will find themselves rejected by physicians, as current legal and ethical standards generally grant physicians full autonomy in deciding which patients to treat. This Article evaluates whether the law and standards of professional conduct should afford physicians broad discretion in deciding whether to treat noncompliant patients. It concludes that they should not and calls upon lawmakers and professional associations to place legal and ethical restraints on physicians’ ability to reject noncompliant patients.

Keywords: value-based payment, non-compliance, non-adherence, medical ethics, beneficience, patient autonomy, disparities in health, personal responsibility