The practical utility of gag clause legislation

Efforts to limit gag clauses by state legislatures and Congress have received kudos from many quarters. But without attention to other standard aspects of physician contracts, the effects of gag clauses will continue. Some physicians who feel the difficulties of current medical practice are too onerous will leave the profession if they can; the vast majority who stay, with patients, families, and others who rely on them, will simply try to do their best under these constraints. That means dealing with the effects of severing the patient-physician relationship and with conflicting ethical concerns on an ad hoc basis. And that also means heeding the insight that formal rules may not have their desired effect when, in practice, others don't really need to play by them. Only through refocusing the health delivery system on the patient and public scrutiny of provider terminations and MCO actions can the prohibition of gag clauses truly be effected. Let us hope that this insight is not lost on lawmakers in their efforts to substantively eliminate the effects of gag clauses on patients and physicians in our health delivery system.