The physician is an integral part of the health care system. The staff the facility keeps defines the health outcomes for the patients of that facility. So, it is very important to hire staff that helps create overall health care quality and good outcomes. Sometimes, however, physicians are placed in a difficult position because of the different roles they manage. The definition of a double agent, the marketplace, and the ethical aspect should be considered when defining a physician’s role as a double agent.
Rich (2005) states that the physician has the upper hand in the relationship because of their medical knowledge. This leaves the patient at a disadvantage and causes them to be dependent on the physician when making decisions about their care:
The physician–patient relationship is the quintessential fiduciary relationship because of the vast disparity in knowledge about disease and treatment between the clinician and the typical lay patient. The consequence of this disparity is that the physician has a moral (and ultimately a legal) responsibility to utilize that manifestly superior knowledge exclusively for the benefit of the patient. (Rich, 2005, p. 393)
Therefore, the patient trusts the physician to not only act on their behalf but also make choices that would benefit them. Hicks (2014) states that having this approach may cause problems because “In health care, the physician is both a healthcare provider and an agent of the consumer. The physician’s incentives in the provider role may not be aligned with the incentives of the consumer” (p.479). Therefore, defining the physician as a double agent. Furthermore:
Doctors are agents for two distinct groups. The physician is an agent for the patient, but also an agent for insurance companies-especially in the managed care settings. In balancing both relationships, the doctor must juggle the conflicting principal-agent problems of information asymmetry and third party payment. (Shafrin, 2006, para.1)
As a double agent the physician must satisfy many demands and the most prominent demand may not factor the patient as the highest priority. There are many things a physician is required to do as a double agent. Angell defined that essentially, “Doctors are supposed to tailor their care of patients to save money for third parties” (Angell, 1993, p.282). Those third party payers can manifest themselves in various forms including: DRGs, HMOs, PPOs, the hospital, and even the physicians themselves. Angell provides an example of how physicians save money, “Under the DRG system of hospital reimbursement for Medicare patients, doctors are supposed to be agents for the hospital, discharging patients as rapidly as possible and keeping services to a minimum so that the hospital can game the system” (Angell, 1993, p.282).