First, do no paperwork

  • by: |
  • 02/27/2007
Greek physicians of the Hippocratic period would not treat patients they didn’t think they could “cure.” They believed it was bad for the patient (“First, do no harm”) as well as bad for their reputation. This latter point may seem shocking today, but it was not exceptional in ancient medicine – in fact, it was an integral part of the prognosis process.

When such a situation arose, the ancient Greek physician resigned himself to what was called “noble flight.” (An early example, it should be noted, of health care “spin.”)

But such a thing could never happen today, right?

Well, hopefully – but the current debate over pay-for-performance is re-opening the debate, among many physicians, about the wisdom of accepting difficult to treat patients. What’s old is new again. Consider M&M conferences. While never pleasant, they do serve an important purpose. Now imagine if physicians avoided cases they couldn’t “cure.” Is ignorance really bliss? Can we allow remuneration to trump patient care?

And that's precisely what will happen unless we can more precisely define metrics for pay-for-performance programs that take into consideration multiple variables -- the most important being the individual patient. Otherwise we fall into the morass of so-called evidence-based (read "cost-based') medicine rather than patient-centric care. Saving money by providing anything other than optimum treatment (pharmaceutical and otherwise) is not only penny-wise and pound foolish from an outcomes perspective -- it's also just plain ethically wrong.

Health care isn't a yes/no proposition. The ancient Greeks thought in terms of "cure." Today we think in terms of "treatment." And "treatment certainly isn't binary.

After all, is the ancient Greek fear of damage to one’s reputation really any different than today's fear of reduced payment? We've come too far to stumble on such petty grounds.
CMPI

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

Blog Roll

Alliance for Patient Access Alternative Health Practice
AHRP
Better Health
BigGovHealth
Biotech Blog
BrandweekNRX
CA Medicine man
Cafe Pharma
Campaign for Modern Medicines
Carlat Psychiatry Blog
Clinical Psychology and Psychiatry: A Closer Look
Conservative's Forum
Club For Growth
CNEhealth.org
Diabetes Mine
Disruptive Women
Doctors For Patient Care
Dr. Gov
Drug Channels
DTC Perspectives
eDrugSearch
Envisioning 2.0
EyeOnFDA
FDA Law Blog
Fierce Pharma
fightingdiseases.org
Fresh Air Fund
Furious Seasons
Gooznews
Gel Health News
Hands Off My Health
Health Business Blog
Health Care BS
Health Care for All
Healthy Skepticism
Hooked: Ethics, Medicine, and Pharma
Hugh Hewitt
IgniteBlog
In the Pipeline
In Vivo
Instapundit
Internet Drug News
Jaz'd Healthcare
Jaz'd Pharmaceutical Industry
Jim Edwards' NRx
Kaus Files
KevinMD
Laffer Health Care Report
Little Green Footballs
Med Buzz
Media Research Center
Medrants
More than Medicine
National Review
Neuroethics & Law
Newsbusters
Nurses For Reform
Nurses For Reform Blog
Opinion Journal
Orange Book
PAL
Peter Rost
Pharm Aid
Pharma Blog Review
Pharma Blogsphere
Pharma Marketing Blog
Pharmablogger
Pharmacology Corner
Pharmagossip
Pharmamotion
Pharmalot
Pharmaceutical Business Review
Piper Report
Polipundit
Powerline
Prescription for a Cure
Public Plan Facts
Quackwatch
Real Clear Politics
Remedyhealthcare
Shark Report
Shearlings Got Plowed
StateHouseCall.org
Taking Back America
Terra Sigillata
The Cycle
The Catalyst
The Lonely Conservative
TortsProf
Town Hall
Washington Monthly
World of DTC Marketing
WSJ Health Blog