Hippocratic Hypocrisy

Published April 1, 2002

Managing Editor’s note: The American College of Physicians/American Society of Internal Medicine—a key participant in the Medical Professionalism Project described below—will meet in Philadelphia on April 11-14. The group’s proposed charter will be discussed in a a special session on April 12, PN 042-Medical Professionalism: Does a Physician Charter Make a Difference?

Hippocrates was a Greek physician. His name graces the Hippocratic Oath that, among other things, obliges doctors to “do no harm” and to place the patient’s welfare before their own.

“Hupokritos” was the Greek word for “actor.” Our English term “hypocrite” derives from it. That said, we introduce you to the “Medical Professionalism Project,” an international group of physicians and others who recently published in the AMA Annals of Internal Medicine and the British journal Lancet, “Medical Professionalism in the New Millennium (MPNM): A Physician Charter.”

As to whether this product of their collective wisdom may be described as Hippocratic or hypocritical … well, hypocrisy has been described as the “tribute vice pays to virtue.”

Barriers to Social Justice

The Charter’s premise seems virtuous enough: It defines the doctor’s role as “placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing advice to society on matters of health.” No problems there.

The Charter then asserts the fundamental guiding principles of the medical profession should be “primacy of patients’ welfare,” “patients’ autonomy,” and “social justice.”

Now, two outa three ain’t bad. But the final item—”social justice”—is a nebulous, high-sounding phrase that the left drags around to justify almost anything they care to advocate or undertake. It leads the group to recommend a set of “reforms” (another all-purpose obfuscation) far more hypocritical than Hippocratic.

The Charter speaks of the need to “reduce barriers to equitable health care.” Why everybody should receive the same medical treatment eludes us, but we press on.

Whence cometh the “barriers” the Charter seeks to address?

From poverty, certainly. That’s why doctors used to do charity work and lowered their fees as a matter of routine professional obligation and personal fulfillment.

But today, the greatest barriers are institutional. One is an imploding, employment-based health-insurance system. Another is the HMO system, a bizarre perversion of capitalism in which money is made by withholding goods and services.

And yet another is the government, which bureaucratically rations and denies care in a manner best described as “Franz Kafka Meets Alice in Wonderland,” and which is always on the verge of going broke.

Not Likely

If the Medical Professional Project really wants to lower barriers, it might consider returning real power to both halves of the doctor-patient relationship. That “reform,” however, does not rank high on the Project’s priorities.

“While meeting the needs of individual patients,” the Charter states, “physicians are required to provide health care that is based on the wise and cost-effective management of limited clinical resources. The physician’s professional responsibility for appropriate allocation of resources requires scrupulous avoidance of superfluous tests and procedures” because this “diminishes the resources available for others.”

An obvious question arises. How is a physician to know what is or isn’t available for “others”? Who are these others? Are they out in the physician’s waiting room, or 3,000 miles away? And who is to tell the physician what is or is not in short supply, beyond the scope of his or her own practice? The government? The insurance companies? The HMOs? We’ve had a half-century’s worth of experience in how they make these decisions … and the welfare of patient or doctor never seems high on their list of priorities.

Why Scarcity at All?

And yet another question arises: Why should there be chronic scarcity of health care at all?

In a market system, when people want more of something, they usually get it. There is no inherent reason why the health care system cannot deliver medical abundance, save for the manufacture of scarcity by organizations, institutions, and individuals whose agendas—be they getting rich or getting re-elected—always seem to trump the free and proper practice of medicine.

Finally, the Project’s new breed of medical professionals would have a “commitment to honesty with patients” when errors or accidents occur, the better to preserve “patients’ trust.” No quarrels there. But the Charter also speaks of “societal trust” based on “reporting and analyzing medical mistakes” to provide “the basis for appropriate prevention and improvement strategies.” Strategies strategized by whom, and toward what economic, legal, and political ends?

Once again, we find ourselves offered a spurious “social justice” that requires addressing inequities the reformers themselves have created and still countenance. Not a bad definition of hypocrisy in action.

As for Hippocrates, he understood very well that social justice in medicine is best achieved one patient at a time, in the privacy and autonomy of a unique relationship. He would no doubt have agreed that letting governments, corporations, and miasmic humanitarians dictate the terms of that relationship would violate his Oath.

It would, indeed, do harm.

Dr. Michael A. Glueck writes extensively on medical issues. Dr. Robert J. Cihak is the immediate past president of the Association of American Physicians and Surgeons.