The Attack on Doctor’s Hippocratic Oath
By Betsy McCaughey
Patients count on their doctor to do whatever is possible to treat their illness. That is the promise doctors make by taking the Hippocratic Oath. But President Obama’s advisers are looking to save money by interfering with that oath and controlling your doctor’s decisions.
Ezekiel Emanuel sees the Hippocratic Oath as one factor driving “overuse” of medical care. He is a policy adviser in the Office o Management and Budget (OMB) and a brother of Rahm Emanuel, the president’s chief of staff.
Dr. Emanuel argues that “peer recognition goes to the most thorough and aggressive physicians.” He has lamented that doctors regard the “Hippocratic Oath’s admonition to ‘use my power to help the patient to the best of my ability and judgment’ as an imperative to do everything for the patient regardless of the cost or effects on others.”
Of course, that is what patients hope their doctor will do.
But President Barack Obama is pledging to rein in the nation’s health care spending. The framework for influencing your doctor’s decisions was included in the stimulus package, also known as the American Recovery and Reinvestment Act of 2009.
The legislation sets a goal that every individual’s treatments will be recorded by computer, and your doctor will be guided by electronically delivered protocols on “appropriate” and “costeffective” care.
Heading the new system is Dr. David Blumenthal, a Harvard Medical School professor, named national coordinator of health information technology. His writings show he favors limits on how much health care people can get.
“Government controls are a proven strategy for controlling health care expenditures,” he argued in the New England Journal of Medicine (NEJM) in March 2001.
Blumenthal conceded there are disadvantages:
“Longer waits for elective procedures and reduced availability of new and expensive treatments and devices.” Yet he called it “debatable” whether the faster care Americans currently have is worth the higher cost. Now that Blumenthal is in charge, he sees problems ahead.
“If electronic health records are to save money,” he writes, doctors will have to take “advantage of embedded clinical decision support” (a euphemism for computers instructing doctors what to do).
“If requirements are set too high, many physicians and hospitals will rebel — petitioning Congress to change the law or just resigning themselves to . . . accepting penalties,” he wrote in NEJM early this month.
The public applauded the new requirement for electronic records, not foreseeing that it would put faceless bureaucrats in charge of your care.
Having medical records instantly available is beneficial. Delivering current research to doctors electronically is also important. The often-cited 2003 study from the Rand Corp. found that about half of patients did not get optimal care.
But under treating patients was the larger problem: 46% of patients failed to receive needed treatments, while only 11% got treatments they didn’t need. That’s why prompting doctors to do the right thing will not curb spending — a point that Dr. Blumenthal has also made in his writings.
To reduce spending, as President Obama promises, doctors will have to be pressured to deny care. Rand reported that Canada allows few cardiac procedures for patients age 65 and older. In critiquing the Hippocratic Oath, Dr. Emanuel calls for training medical students “to move toward more socially sustainable, cost-effective care.” He says the trend “from ‘do everything’ to palliative care shows that change in physician norms is possible.”
What he fails to see is that government should not be interfering in decisions about when it’s time to say enough is enough to medical care.
Dr. Emanuel also cites medical comforts for pushing up costs: “Hospital rooms in the United States offer more privacy, comfort and auxiliary services than do hospital rooms in most other countries,” he noted in the Journal of the American Medical Association last June.
President Obama has appointed impressively educated advisers. But no matter how many degrees they have, it’s still important to examine what they think.
The views articulated by Drs. Emanuel and Blumenthal are contrary to American values. Such views are common in Europe, where some governments create an environment of medical scarcity. Do Americans want to copy Europe?