I am not a curmudgeon, but I am worried about the current plight of health care and the attack on the Hippocratic Oath. Bigger health care is sold as better and more efficient with the premise of lowering health care costs. The promised financial outcomes and efficiencies for the physician and their patients have not materialized. Instead, while physicians struggle with non-clinical demands on their time, patients are being pushed to “workaround” solutions built upon profit and not building relationships. Are the solutions truly “doing no harm?”
Physicians are facing burnout, loss of autonomy, decreased satisfaction, rising rates of depression and are seeking ways out of medical practice. I wonder if the lack of joy once found in medicine is related to the Hippocratic Oath being under attack. Are we being hypocritical?
The Hypocritical Oath
I swear to fulfill this covenant if I am told this is best for me by my employer:
I will question the hard-won scientific gains of those physicians in whose steps I walk and will develop algorithms and policies that replace physician judgment.
I will apply for the benefit of the hospital system, with the help of a consultant, all measures required of the federal government, avoiding those twin traps of being penalized for not meeting meaningful use or low patient-satisfaction scores.
I will accept that the art of medicine now includes electronic medical records, keeping patients in-network, meeting assigned quality metrics. At times, I will understand that these demands will outweigh the value of the surgeon’s knife, a primary care provider’s guidance or a condition treated without a prescription.
I will recognize that my colleagues are stressed and feeling burnout. They may lash out at me as I did not get the corporate memo or because I am asking them to not only see the patient but spend an hour documenting the encounter.
I will respect the privacy of my patients so as not be fined for HIPAA violations. I will tread with care in matters of life and death as I fear a malpractice suit if my patient should have a bad outcome despite receiving the best care I can provide in my current environment. If it is given me to save a life, thanks should not be expected nor will it likely be given. I will accept the awesome responsibility of a physician and will face with awareness my own burnout and acceptance of mild depression. Above all, I will pray to God for resilience.
I accept that I may not be aided in treating a sick human being, but rather will be offered webinars and email reminders of how to document adequately, meet productivity benchmarks and pay and meet maintenance of certification requirements. If a patient’s illness may affect the person’s family and economic stability, I will not know as I provide care but billing and coding is provided by an outsourced company. The insurance company, government and/or my employer shall dictate what I am able to be reimbursed. I will not ask nor will I be informed transparently about the real cost of care that I provide nor the cost of devices or pharmaceuticals from which I choose.
I will prevent disease whenever I can, but since the time needed for care and prevention is not reimbursed, then I accept that I may not be able to provide this care. The internet and the media in all forms will be the source for the medical education of my patients.
I will realize that politicians are far better to create health care solutions for society. I will embrace frequent political change that impacts the care I provide and my livelihood without too much complaint.
I will also realize that those who profit from the healthcare industry are seen as good business people. As a physician, I will recognize that I am more likely to be judged as placing margin ahead of mission.
I must ask myself and my professional colleagues how long I can practice clinical medicine and meet these demands. I may need to think about an MBA, MHA or other degrees to move “up” and spend more time away from patients to balance my life, reduce night call and the threat of malpractice and/or impact my decreasing income.
Overall, I will continue to seek ways to remind myself of my idealistic goals upon entering medical school. Maybe, just maybe, today I will get a thank you for the care I provide instead of an administrator’s complaint, low patient satisfaction score or an insurance denial.
Mick Connors is a pediatric emergency physician.
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