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.

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.

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