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Didn’t you take an oath?

Didn’t you take an oath?

I sometimes hear this question when someone is frustrated by the financial barriers to health care. I believe that applying a business model to healthcare is unwise and dangerous. Essential human services do not perform well as for profit businesses. If profit is the goal, people get crushed in the rush to improve the bottom line and satisfy investors.

Doctors work hard, make a pretty good living and do not have to be worried about being unemployed. Physicians practice medicine because they love to care for people. But, they are usually very poor businessmen and businesswomen. That weakness in finance has been exploited by the payor system, and most physicians are working as employees to satisfy the payor’s demands for a labor force. Physicians, including organized medicine, have not been active enough in defending our patients against the abuses of the for profit economic system. This is a new challenge.

It might be refreshing to review the “Oath” to gain a new perspective. Here is the contemporary version written in 1964 by Dr. Louis Lasagna of Tufts University. I will let it stand on it’s own, but it is clear that there is a mandate to protect the patient and the family’s economic stability. Physicians do not take a vow of poverty. What is called for in the oath is for physicians to confront financial abuses as they occur and protect patients from unnecessary expense.

I swear to fulfill, to the best of my ability, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. I will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of over treatment and therapeutic nihilism. I will remember that there is an art to medicine as well as science, and that warmth, sympathy and understanding may outweigh the surgeon’s knife or the chemist’s drug. I will not be ashamed to say “I know not”, nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play God. I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, be respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.