I recently moved to a new town and found a primary-care physician who seemed to check all the boxes, but during my initial exam, he went off on a lengthy diatribe about Bill Gates, delving deep into conspiracy theories about his being the evil mastermind behind the creation of the coronavirus and the architect of a secret sterilization program in Africa. He also revealed that although he very likely will be among the first to receive a coronavirus vaccine, he will put it in his fridge and wait until millions of others have taken it and proved that it works.
The first part makes me question his intelligence, but the second strikes me as seriously irresponsible: He’s basically advising his patients not to take a vaccine. Needless to say, I will not be returning to this doctor, but I feel I should at least post comments on doctor-review sites about his behavior, if not report him to some authority. Do you have any advice? Name Withheld
People who should know better can harbor all sorts of unhinged suspicions. Often, though, they’re sufficiently in touch with reality that they don’t readily voice them. It could take a few beers, and a wary glance around them, before they’ll share their darkest, dankest convictions. But here we’ve got a doctor seeing a patient for the first time and emptying an IV bag of crazy. This is worrying.
He could still be a skillful practitioner, to be sure. Life would be easier if everything about us pulled in one direction. But you’ve identified a crucial point: When a big part of someone’s job is to dispense medical advice, it matters when the advice is bad. People who fixate, say, on rare negative reactions to lifesaving measures have a highly imbalanced assessment of the situation. Members of the medical profession should be helping to combat vaccine hesitancy, not to promulgate it.
What’s more, if he’s really planning to store this vaccine dose of his in a refrigerator, it probably won’t survive. (The authorized vaccines require long-term storage at supercold temperatures.) So he seems to be poorly informed about the vaccines in all sorts of ways. What you’ve reported is something prospective patients would want to know about a physician. You would be doing them a favor to put this information on the doctor-rating sites we all now have access to. I’ll just stress that it’s important to be scrupulously accurate, setting out the facts, not inferences as to his character or state of mind. And yes, you might also want to make a report to the state medical board; in many states, that’s something you can easily do online.
I don’t know whether the board will do anything; in the triage of the complaints it fields, yours may not rank high. You might have more success if his office were connected to a larger center for medical care and you could notify an administrator there. But a concerned online comment should at least put this physician on notice that his unwarranted diatribes could have an adverse effect on his practice. The sort of vaccine mistrust that he’s spreading can certainly have an adverse effect on public health.
I work in an emergency department in New York City. We treat a fair number of unhoused patients, many of whom have alcohol-abuse or untreated psychiatric disorders or both and live on the street. Many also test positive for Covid-19. Without a medical reason to hospitalize them, we send them back on the street with instructions to wear a mask and to isolate as best as possible under their circumstances. Unfortunately, I’ve seen some of these individuals whom I know to be infected with Covid-19 out in the community without a mask, yelling in the faces of passers-by. What is my obligation to the community versus my obligation to Health Insurance Portability and Accountability Act (HIPAA) privacy laws? Someone facetiously suggested we give them a sign to hold, telling people to stay at least six feet away. As an alternative, should we hospitalize these individuals for public-health reasons so they can quarantine in a hospital setting even though they are medically stable? The hospitals will soon be full of Covid-19 patients, and beds are scarce. Name Withheld
Even in ordinary times, keeping people in hospital beds for reasons other than their own medical needs is a bad idea. When beds are needed for the seriously ill amid a pandemic, it’s a terrible idea. Ideally, we would have substance-abuse and psychiatric programs for everyone who needs them, but we don’t. Even if we did, we couldn’t force people to take part in them, and some people would be around on the streets who could benefit from help they aren’t getting.
When people pose medical threats to others, the HIPAA rules may permit you to notify public-health authorities without their consent; more important, those rules stop you only from passing on “individually identifiable health information,” so, at least in theory, you could tell people they have been exposed to the virus as long as you don’t let them know who exposed them.
But in practice, you can’t follow these patients around and notify everyone they expose to risk. And though recklessly exposing others to harm may technically be a criminal offense, I don’t know that anyone in New York has been charged with it. The burden, ultimately, lies with everyone to do his or her best to maintain social distancing with the strangers with whom they share the streets. As with so many problems of this sort, our best option is simply the less bad one.
I’m an associate at a small media-and-entertainment law firm in New York. Though my family is not wealthy, they were able to contribute to my law-school tuition, and this, combined with odd jobs I did while in school, enabled me to graduate without much student debt. Three years later, I now have just over $10,000 in outstanding loans, which I could pay off by dipping into savings. However, I keep seeing headlines about President-elect Biden’s proposal to eliminate $10,000 of every American’s student-loan debt. Assuming this plan materializes, would it be wrong for me not to pay off my student loans and just wait until they’re canceled? If so, would it still be wrong if I donated some of the money I saved to support disadvantaged students? Sam, Brooklyn
That’s a big assumption. President-elect Biden’s plan, which involves using federal funds toward paying down private loans (the current administration has already introduced a temporary moratorium on the repayment of federal loans and suspension of interest on them), will presumably require legislation that the Senate may not agree to. But if the pledge indeed becomes a program, the first $10,000 in debt relief — which isn’t conditioned on the current income of the debtor — is meant to be part of a stimulus that will help deal with the economic effects of the pandemic. Given the stated objective, the fact that you don’t need the loan canceled doesn’t make it inappropriate to accept the offer, so long as it increases your spending on other things.
The way you talk about focusing your spending on the disadvantaged suggests that you will have somehow wronged them. This isn’t the case. It’s commendable to give money to good causes, but it would perhaps be more commendable if you did so not out of a misplaced sense of guilt but out of a sense of purpose. You should support these causes because you believe in them.
Of course, you may not want to participate in the loan-forgiveness program because you think this form of stimulus is wrong or just wrongheaded. Some people ask why the money isn’t being directed specifically to lower-income people, many of whom don’t have college student loans. Others ask whether the proposed program is fair to those who have already successfully struggled to pay off their loans. Still others argue that college education is a public good and therefore tuition debt is itself unfair, because college ought to be free. There’s an array of arguments here, trailing an array of empirical and ethical considerations. But the right way to respond to such issues isn’t to refuse to participate; it’s to engage in the public debate about what we should be doing with money that, in some sense, belongs to all of us.
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