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03/22/2015

Rebuilding Trust

The Texas Tribune reported this week that legislators in Austin have proposed a bill that would forbid physicians from asking their patients about guns.  Joe Gibes has commented on this issue in this blog (“It’s Not Primarily About the Guns” on Sept. 12, 2014).  In Texas, this is set against the backdrop of Open Carry legislation, a change in rules for those licensed to carry a handgun that would do away with the requirement they conceal their weapons.

While this legislation is related to debates about guns and recent gun violence, I think this issue is more closely related to the lack of trust in the medical profession.  Take the vaccine debate of a couple months ago (and Senator Rand Paul’s tweet).  This is tied to concerns about autism, but it reveals a larger mistrust in medical science and healthcare policy.  I think this was exacerbated by the Ebola outbreak in Dallas and questionable management at both the hospital level and county/public health department level and even the federal CDC.

So, now more than ever, we need to rediscover the sacred patient-physician relationship.  Some patients may be wary of a doctor trying to make a buck off their care (see Lesley Stahl’s reporting on the revenue which comes from pharmaceutical companies in the course of cancer treatment).  Doctors may be concerned with the platoon of lawyers tagging along with some of their patients.  Or maybe it is that guy with the MBA running the hospital.  And, of course, there is the government.  A great cloud of mistrust hangs over Washington as Congress continues to float ideas about changing the Affordable Care Act and the Supreme Court weighs an ACA challenge.

I suggest that physicians take the lead on this.  A simple adherence to a Hippocratic or Hippcratesque Oath which emphasizes the patient-physician covenant before monetary reward (and accompanying “financial toxicity”), political agenda, or personal pride would do a world of good.  A simple commitment to “avoiding any voluntary act of impropriety or corruption” before a group of colleagues would lift medicine to another level.  The concept of “entering a home for the benefit of the sick” would inspire confidence in parents bringing young children to the clinic along with concerns about vaccination.

And draw a line.  Provide some clarity to the debate.  We’ll do business with these pharmaceutical companies and these hospital administrators.  If these medical equipment manufacturers hold to this same high standard, we’ll do business with them.  But no one else.  Period.  The doctor-patient relationship means that much to us.  I think they will find many patients interested in that kind of service, that kind of care.

And, wow, what a better environment in which to practice medicine.  I think even the receptionists will be lining up to work for these docs (Don’t have to answer those phone calls from those lawyers any more; Hallelujah.).  Who knows?  There might even be an insurance company out there that will say, “We always wanted to work with docs who wanted to get back to the healing art of medicine.  We might even come out with a fair insurance plan … no strings attached.”  Even one or two clinics that could carve out such a niche could get the medical societies to take notice.  When I was doing my grad work in Chicago in the 2000s, someone told me that Lawndale Church was getting many referrals from the public health department in Chicago because the church (yes, that’s right, the church) and its clinics were so much better as healthcare partners.  Lawndale decided long ago it was going to do certain things certain ways simply because it was right, it was Christian.  Eventually, Chicagoans began to take notice.

For Further Study

Peter Tyson, “The Hippocratic Oath Today” (From 2001), March 27, 2001, NOVA.

“Yet paradoxically, even as the modern oath’s use has burgeoned, its content has tacked away from the classical oath’s basic tenets. According to a 1993* survey of 150 U.S. and Canadian medical schools, for example, only 14 percent of modern oaths prohibit euthanasia, 11 percent hold covenant with a deity, 8 percent foreswear abortion, and a mere 3 percent forbid sexual contact with patients—all maxims held sacred in the classical version. The original calls for free tuition for medical students and for doctors never to “use the knife” (that is, conduct surgical procedures)—both obviously out of step with modern-day practice. Perhaps most telling, while the classical oath calls for “the opposite” of pleasure and fame for those who transgress the oath, fewer than half of oaths taken today insist the taker be held accountable for keeping the pledge.”

Ben Mitchell, “The Christian Hippocratic Tradition in Medicine,” Nov. 5, 2010, The Center for Bioethics and Human Dignity.

“Hippocratic Oath” and “History and Meaning of the Oath” from the American Hippocratic Registry.

 

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