INDIANAPOLISIn a development bioethicists and health-care industry professionals are watching closely, the board of directors of Indiana HMO PhysCare-Plus, one of the largest and most powerful HMOs in the nation, announced Monday that the Hippocratic Oath is currently "under review."
According to board members, the 2,400-year-old oath, attributed to the Greek physician Hippocrates and generally acknowledged as the cornerstone of medical ethics, is "outmoded and no longer economically viable in today's complex, rapidly changing health-care environment."
"Here at PhysCare-Plus, our goal has always been the same: to provide customers with dependable, first-rate health care. But it is becoming increasingly difficult to do so when we are hampered by an ancient moral code penned by a contemporary of the historian Herodotus somewhere between 470 and 360 B.C.," said Dr. Cedric Samms, head of the PhysCare-Plus board. "While the oath is admirable for its idealism, it simply does not take into account the many complexities and economic realities of medicine in the modern age."
Added Samms: "The personal touch.... That's the PhysCare-Plus difference."
According to Samms, the Hippocratic Oath is too narrow and inflexible, placing too many restraints on health-care professionals and requiring doctors to provide additional services which undercut their profits and hinder their ability to remain competitive. Because of the medical profession's strict adherence to antiquated moral principles and dogma, Samms argued, both doctors and HMOs are adversely affected.
"Take, for example, the portion of the oath which states, 'I will follow that system of regimen which, according to my judgment, I consider for the benefit of my patients,' Samms said. "For years, doctors have complained that the notion of practicing medicine with the patient's health as the number-one priority is not only outdated, but unfair. By putting the patient's welfare before cost considerations, doctors place themselves at risk of antagonizing HMOs, which pay for the bulk of medical bills under the current system. Every time a precautionary electrocardiogram is done on someone suffering from chest pain, it is the HMOs that truly suffer."
Also under intense scrutiny is the line, "With purity and holiness I will practice my art."
"Medicine has changed a great deal over the last 2,400 years, and 'purity' and 'holiness' are strong words that may no longer be viable given current cost outlays," PhysCare-Plus vice-president of operations Dr. Kyle Loveland said. "And, as far as the use of the word 'art' goes, perhaps in ancient Greece physicians could consider themselves artists, but today's medical industry is a multibillion-dollar business." PhysCare-Plus officials have proposed changing "purity and holiness" to "acumen and savvy," and to change the term "art" to "career."
Of all the disputed elements of the oath, however, the passage drawing the most fire is the one that reads: "Whatever in connection with my professional service... I see or hear in the life of men... I will not divulge, reckoning that all should be kept secret."
"There is no way an HMO can properly function bound by such a rule," said PhysCare-Plus member-accounts departmental supervisor Toby Francis. "HMOs must be free to disclose patients' medical, personal, and financial information to insurers. How else can we determine what treatments a patient is or isn't eligible to receive? If someone needs a new lung and they don't have the necessary funds to pay for it, how are we supposed to know not to perform the surgery? I can't tell you how many cost overruns have been rung up as a result of doctors providing life-saving operations in accordance with the Hippocratic Oath, only to find out afterwards that the patients weren't covered. In a case like that, the surgery turns out to be for nothing. I get burned up just thinking about it."
If approved by the PhysCare-Plus board, the revised Hippocratic Oath is expected to have a major effect on the health-care industry, with other HMOs across the U.S. likely to follow suit. But regardless of whether or not the revised Hippocratic Oathtentatively titled the "PhysCare-Plus Family Econo-Plan Quality Pledge"is passed by the board, one thing is certain: Health-care providers' attitudes are shifting.
"As the millennium approaches, the medical industry must look toward the future, not the past," Samms said. "After all, as Hippocrates himself said, vita brevis. Life is short."