Do no harm.
"To abstain from doing harm" is an essential part of an oath that has been taken by physicians and millions of other caregivers dating back to the fifth century B.C. Some credit it to the father of western medicine, Hippocrates, who believed in an ethically binding promise between caregiver and patient. Long considered the quintessential benchmark of medical honesty and integrity, it's no less than a commitment to the compromised, the vulnerable who suffer.
As the Affordable Care Act's open enrollment period approaches on October 1st, the nation finds itself plodding through a political debate that rarely, if at all, actually considers the sufferer. Now seems as good a time as any to get back to the genus of the health care provider and health care recipient relationship.
First, do no harm.
Imagine if everyone with any engagement within the health care system, including political pundits and lobbyists, could promise to do no harm. The pharmaceutical and medical device companies, the insurance agencies, the hospitals, the doctors, politicians, patients and advocates. What if we believed all of us shared a crucial responsibility to the success and/or failure of every patient, both physically and fiscally? Health care providers and their adjuncts don't need to believe in a system of socialized medicine to engage in such an idea. Instead, we simply need to commit to do what is right and fair for those with the heartbeats who place their trust in us.
When the dedicated, expert hospital staff saves a life -- yet the survivor loses all of his assets down a fiscal rabbit hole because of wildly inflated medical bills -- how is the hospital honoring its vow? The doctor may not even know that the hospital charged too much or the insurance company paid too little. Maybe the doctor does know, God (or at least ethos) forbid, but he feels justified in overcharging Patient A to get back the money he lost to Medicare on Patient B. Who cares that the recycled $5 blanket in the ER was billed to hundreds of patients at $85 time and time again, or that the patient's $4000 anesthesiologist was "out of network" or that the cup of apple juice in post op was $12?
When the insurer decides not to honor its obligation to pay for the medical services of a woman who underwent brain surgery, is there an excuse that's simply big enough for such denial of vows? When a medical device fails, ambulance chasing class action lawsuit lawyers fill the cable TV airwaves with their, "Have you been wronged?" vitriol, it is horrific, unfair and wrong. But when the medical device manufacturer simply makes devices astronomically expensive, well beyond what it costs to create and market it, why is there no harm in that?
In the legal world, ignorance of the law is no excuse. The hospital claiming it had no idea the third-party biller that the hospital hired for "cost efficiency" was forcing people to sign credit card receipts while suffering heart attacks in the ER? No excuse. The doctor who gouges someone who in turn loses every thing because the patient was raised to do "the right thing?" No excuse.
And there are the ones who say, "I was just doing my job," in the billing department or, "I get a bonus when I tell the person 'no', and I need the money" at the insurance company. No excuse. The patient who lies about a condition to get disability or even something as seemingly trivial as a handicapped parking pass? No excuse. We are not talking about trivial matters, but about human life and livelihood.
In many states, it is illegal to "price gouge" or take financial advantage of citizens during a time of natural disaster. You can't sell a $500 snow shovel to someone during a blizzard. No $200 bottles of milk before the hurricane. Why? Because it is ethically and morally wrong to exploit groups of fellow Americans in times of crisis for unfair financial gain. And yet, this happens to millions of patients and their families every day, one by one, within our medical system. The difference? There's not a massive televised event or YouTube video or tweet around such cases. The financial losses of the patient and the burdens placed on their families happen well outside the hospital doors, and only a scant few get brief mentions in the media.
The man who loses all that he had worked for because he had the audacity to believe in insurance that cancelled him and a hospital that wanted to meet its numbers? To his family, a wife and small child living in Arizona, it is beyond catastrophic. We know, because we spoke with him last week. Add in the millions who are victims of a system every day of year, and it is most certainly a national disaster beyond measure.
Am I that "Cockeyed Optimist" of South Pacific fame? Maybe. But moreover, I believe we can and must honor our oaths. Our obligations. Our promises.
First and foremost, may we do no harm.