Doctors’ Allegiance and the Hippocratic Oath: Patients vs. Profits

by Philip Caper, M.D.

The Maine Medical Association recently updated a 2008 poll of their members that asked the question “When considering the topic of health care reform, would you prefer to make improvements in the current public/private system (or) a single-payer system, such as a ’Medicare-for-all’ approach?” In 2008 52.3 percent favored the Medicare-for-All approach. In the updated poll, released last week, that number had risen to 64.3%.

It’s pretty unusual for two-thirds of a group of doctors to agree on something as controversial as a single-payer health care system. Until recently doctors formed the core resistance to “government-run” health insurance in the U.S.

There are a number of factors that account for this impressive change, but the huge administrative burden on practicing physicians created by our plethora of private insurance schemes is certainly near the top of the list.

The other day I spoke with a Maine physician nearing retirement and looking forward to it. She was recently returning home after a long day in her practice, carrying her “homework”, a pile of administrative paperwork several inches high. Her husband asked her how she got so far behind in her paperwork. “I wasn’t behind at all”, she replied. She did this much paperwork, mostly insurance forms, at least twice a week.

American physicians spend at least three times as much time, money and effort on administrative work related to payment and insurance coverage as our Canadian brethren, with their single-payer system. Administrative hassle is a major factor driving more and more American doctors to sell our practices to large corporations that take care of the of the back office work. The Affordable Care Act has only added to that burden. 60 percent of doctors now work for corporations and that number is growing.

Working for a corporate provider of health care services is a mixed bag. He who pays the piper calls the tune. As both for-profit and non-profit health care corporations have become increasingly focused on the bottom line, doctors working for them have come under increasingly subtle and not-so-subtle pressures to generate revenue for their employers.

Some tests and procedures are more profitable than others. Increasingly, doctors’ “productivity” is being measured by the amount of profitable revenue we produce, rather than by the results we get for our patients. But in health care, profitability is a very unreliable measure of value because doctors’ fees and other healthcare prices are often set arbitrarily.

 When we graduate from medical school most of us take the Hippocratic Oath, swearing our primary allegiance to our patients. Young doctors tend to take their oath very seriously. Most doctors truly want to do what’s best for patients, not their insurance company or our employers’ bottom line.

 But in today’s corporatized and increasingly monetized health care environment, the demands for generation of profit often directly conflicts with our clinical judgment. The belief that doctors and other healers act as stewards for our patients’ welfare has long earned us a special place in society and the trust of our patients. That position and that trust, so critical to healing, is now being threatened.

 This conflict has made many doctors very angry. Practicing a profession that has traditionally been a calling has become a business. Doctors today are caught in a system that has been corrupted by an excessive focus on money that is forcing us to behave in ways that conflict with our professional ethics. We are growing very tired of being told how to practice medicine by insurance company bureaucrats and corporate MBAs.

 This is another major cause of the burnout being experienced by increasing numbers of doctors. Many older doctors are now simply looking for a way out. Others are calling for system-wide reforms that will allow them to return to focusing on the welfare of their patients. Hence the results of the recent MMA poll.

 In an excellent new book called “What Matters In Medicine”, long time Maine family doctor David Loxterkamp points out that medical care, while often utilizing scientific jargon, methods and tools, is at its core a profession about relationships, not profits.

That’s something the bean-counters and policy-wonks who have become increasingly influential in determining the nature of our corporatized healthcare system seem unable to understand.

 It’s time to remove corporate profit from the financing of health care and perverse financial incentives from the direct provision of services. It’s time for improved Medicare-for-All.

 

Suggested reading:

1.    Goodnough, A. New law’s demands on doctors have many seeking a network. New York Times, March 2, 3014.

2.    Brill, S. Health insurance. Bitter pill: why medical bills are killing us. Time magazine, February 20, 2013.

3.    Loxtercamp, D. What Matters in Medicine: Lessons from a Life in Primary Care. Ann Arbor, MI. University of Michigan Press, 2014.

One liner: Two of three physicians in Maine favor single-payer Medicare for all over what we have today—a corporate culture run by private insurers seeking profits at patients’ expense.

Abstract:  The ACA perpetuates and accelerates profiteering throughout a corporatized health care industry. Many physicians, now employed by big hospital systems or sometimes even by insurers, are angry with the transformation of their calling into a business controlled by others. Physicians are left in an ethical bind—to go along with the drive for profits of their employers and insurers, or try to resist and put their careers in jeopardy.

 

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Tag lines:  Obamacare; ACA; Hippocratic Oath; Maine Medical Association; physicians’ allegiance; corporate health care; professional ethics; David Loxtercamp; Steven Brill

Reprinted with permission of Bangor Daily News, where it appeared on March 20, 2014.