Table of Contents
What is reasonable for patients do expect their doctors to do? Should patients always expect their doctors to recommend what is best for them, no matter what? Or is the reality that doctors don't have the authority that they once did because insurance companies have taken it away from them?

Choosing What Is "Good" For The Greatest Number Disastrous For Individuals
Although it would seem unappreciative of a patient to raise the issue, there are grounds to criticize the idea that doctors should always do what is in the best interest of their patients.
They should be made on the basis on what is good for the country as a whole.
If a baby born prematurely needs delicate heart surgery, maybe it would be better to let the child die than to spend resources that could help a greater number of people. Or maybe it is not moral to give an old man with dementia medication for his bladder infection. Just let him die slowly from the infection. It's not like he knows what is happening.
Generalizing "doctor knows best" to the general population results in grotesque inequities for individuals and cultivates insensitivity to patient needs. But "doctor knows best" has been largely replaced by "insurance company knows best" and "HMO knows best" that have the same effect.
The Tyranny Of "Best Practices"
One major US insurer, United Health Care, has advertised its insurance policies with the slogan "Health in Numbers." Just trust their data and their expert opinion, and you are guaranteed to be as healthy as possible.
But the fact is, not every patient reacts the same way to every course of therapy. And the more patients know about their conditions, from personal experience, from participation in forums, from support groups, from articles and books, and from the Internet, the more choices they demand--at the same time the bureaucrats of the insurance companies are insisting on lower costs by providing everyone not just with the same level of care, but the exact same care for the same diagnosis.
No doctor knows the course of disease in every patient or every side effect of every medication. The path to health is not the same for everyone. Personal preferences really matter.
So what is the way for a patient to navigate the system? Probably it is a good idea to avoid doctors who are "minimalists," inclined to be skeptical of any treatment, eager to stay within the rules. It's probably better to find a doctor who is a "maximalist," who will offer every treatment that holds potential to make you better, as long as it does not produce serious side effects that you do not have an opportunity to accept or reject.
See Also: Why Your Cancer Specialist (in the USA) May Be Forced Out of Business
Even better, however, is to find a doctor whose staff has the energy and tenacity to get you the treatments you need with the coverage you have. Treat these rare doctors and their staffs with care. They are your best allies in finding the medical treatment you need in a country obsessed with cost.
- Pamela Hartzman and Jerome Groopman. How Medical Care Is Being Corrupted. New York Times. November 18, 2014.Photo courtesy of Frances1972 via Flickr: www.flickr.com/photos/frances1972/2247431698
- Photo courtesy of Emuishere Peliculas via Flickr: www.flickr.com/photos/bizzzarro/441904256