Some HMOs encourage their general physicians to follow what is known as the gag rule. The gag rule, an extremely controversial matter regarding HMOs, prevents a physician from telling you about the availability of certain possibilities for the treatment of your condition.
As a result, there may be instances when members of an HMO do not receive full information about their treatment options. When this occurs, it is impossible for you to make a good decision about how to proceed with your medical care.
If you suspect that your general physician has not told you about every reasonable possibility for your treatment, you should do several things immediately. The first thing to do is schedule a face-to-face appointment with your general physician. At that meeting, ask him or her pointblank questions like the following.
- What are all the medical possibilities available to me for this condition?
- Have we discussed every reasonable option I have for dealing with my condition?
- Is there any other information I might obtain from testing or anything else that would help me make the best possible decision?
Although you do not know exactly what your HMO requires of your general physician in regards to providing information to you, these sorts of direct questions make it very difficult for most physicians to withhold important information. q4Ask your general physician about obtaining a second opinion The next thing you should do is tell your general physician that since the matter is so serious, you would like a second opinion.
Your HMO contract may entitle you to such an opinion, and if not, there is nothing to prevent you from obtaining it at your own expense. Your second opinion request lets your general physician know that his or her advice will soon be going head-to-head with the advice of another physician. If you continue to believe that important information is being withheld from you, you should definitely consult another physician—even if it means spending some of your own money.
Tell Your General Physician That You Are Planning To Discuss the Matter with Others
The next thing you should do in this situation is let your general physician know you are planning to discuss the matter with other people such as family members or friends. This will suggest to most general physicians that there is a reasonable chance that you will be pursuing the matter further. General physicians want to keep HMOs happy, but they do not want to be found negligent doing so.