I regard our independence to practice our craft as one of the principal rights we have as physicians and surgeons. We are given this right not by the university that granted us our degree, nor by local, state, or federal authorities, but by our patients. Our patients lay bare their bodies and souls to us, often times complete strangers, without a written or verbal contract but with unstated expectations. They enter this covenant with the hope, and yes, the expectations, that we are equipped both intellectually and ethically to cure or at least ameliorate their ills. Therein lies the sometimes overwhelming responsibility we have as healers. “I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.” Implicit in this classical translation of a portion of the Hippocratic Oath is the physician’s vow to maintain the good of the patient as the highest priority. Possibly the most difficult challenge to today’s physician with this portion of the Hippocratic Oath is economics. To practice our art, we have expenses, staff, rent, and supplies. We also have responsibilities to our family, especially our parents, spouse, and children. Our expenses continue to escalate without a parallel increase in our income stream. The conflict emerges when providing optimum care to patients is inversely related to making a living. Therein lies the basis of an ethical dilemma that all physicians must face. Do we use protocols or devices that might yield us great financial rewards, unencumbered by our participation in managed care, even though they have unproven efficacy and an unknown
safety profile? Or should we insist on providing our patients with the appropriate information with which they can make an informed decision?
to be continued…….Bruce R. Gilbert MD PhD