The biggest change in medical practice that has occurred during my 25 years as a physician is the open acceptance of physician employment. Compared to this change, the ACA, EMRs, “Gorillacillins,” and the latest sepsis protocol, combined, aren’t even worth mentioning.
Physician employment was, and is, obviously an intrinsically flawed structure that was considered absolutely unacceptable for obvious reasons for the entire history of medical practice! Now, suddenly physician employment is considered the norm? What a terrible trap we have been lured into. We have been rendered impotent and stripped of the prestige that a “higher calling than profit” previously conferred upon us. But it is our patients that are suffering.
What use are medical ethics to a physician if he/she must “buckle under” and obey the mandates of a boss that is trained in business (if trained at all, as there are no standards of education or experience for administrative positions) and purely profit driven?
When did physician employment start? Well, that is not as clear as the advent of physician employment contracts signed (or not signed … if you don’t bill enough RVUs or if you dare to question the CEO’s mandate to see a patient every 10 minutes, and supervise four mid-levels at the same time) by the CEO.
Profit cannot be allowed to act as the primary driving force in medical care. It is morally damaging for a physician to be forced to maximize the profit he/she makes from the suffering, misfortune, and pain of others. As medical students, we do not swear to “make every dollar possible at every patient encounter.”
Our oath provides that we should have a comfortable living, and prestige. Certainly, hospital administrators should also receive the fair “fruits of their labors,” but it is arguable that a $49 million annual CEO bonus violates the spirit of medical care. I believe we should extend our line of altruistic thinking and actions to include the hospital administration.
The oath that follows is intended as a draft and not as a final product. I do not claim much originality, and most of the concepts are borrowed from our Hippocratic Oaths — both ancient and more modern. I believe that many hospital administrators will be proud to agree to and live by such an oath.
Medical administrators’ Hippocratic Oath
I swear to fulfill to the best of my ability and judgment this covenant.
I will realize that as a medical administrator I must place people’s welfare ahead of profit and prestige. If I am unable to maintain this prime directive, I will seek employment outside of the medical field.
I will respect the hard-won knowledge and abilities of the physicians and caregivers with whom I work and may employ. I will assist them in providing the best care possible for those that seek our help.
I will gladly share my administrative knowledge and wisdom with those who are to follow. I will share the concepts herein and counsel my trainees to ensure they find employment that will mirror their ethos. I will assist those not suited to medical administration in their efforts to find a suitable career.
I will work to ensure that resources are available to provide, for the benefit of the sick, all measures that are required.
I will aggressively support and fund the prevention of disease, utilizing those preventative measures that are proven least harmful — and most effective — realizing that prevention is preferable to cure.
I will fund and support equally those effective tests and treatments that are both more and less profitable.
I will realize that resources are not unlimited, and will strive, with the assistance of my providers, to do the most good for the most people with those resources that are available.
I will be very careful with incentives and awards, ensuring that the end result is both safe and beneficial to the people that entrust me with their health and welfare.
I will value and support both the technical excellence of my colleagues and their human graces.
I will not reward or praise overtreatment or therapeutic nihilism.
I will not be ashamed to not know medicine, as medicine is not my realm of expertise. I will defer decisions regarding treatment and testing to my trusted providers.
I will respect the privacy of my patients, holding myself to the same standards to which I hold my providers.
I will realize that the business decisions that I make have powerful and far-reaching effects upon patient care. And I will bear this awesome responsibility with great humbleness and awareness of my own frailty. Above all, I must not play at God.
If I do not violate this oath, may I enjoy life and good health, respected while I live and remembered with affection thereafter.
I would suggest we form a group to discuss and refine the above Oath. A physician group that meets best practice criteria, managed by an administration that agrees to such an oath would indeed be the ideal.
Mark Borden is an emergency physician.
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