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Health care as a business: the ethic of Hippocrates versus the ethic of managed care.

The ethic of Hippocrates is, in an important sense, quite ambiguous. Scholars of the history of medicine or the history of ideas may have certain interpretations-interpretations which generally view the Hippocratic Oath in terms of ancient Greek medicine, particularly of the Pythagorean tradition. The general public in America, however, while being quite unacquainted with the actual text of the Hippocratic Oath, nevertheless has a public conception of that special oath that medical students take as part of the rites of passage from student to physician. That the oath that medical students take might bear only a faint resemblance to the historical Hippocratic document, and that there is no universal uniformity in the words of the oath that different medical schools ask their students to swear, have not prevented there being a popular public conception of the ethic to which physicians are bound. Of the features of that ethic, the one that concerns us here is the notion that when caring for a patient, the physician should have only the welfare of that individual patient in mind. The question of finances should never be allowed to deter the physician from recommending the most medically appropriate of the alternatives. This loyalty to the individual patient is part of what is seen as the special ethical obligation of the physician as a professional. In recent years, however, the practice of medicine has become more a practice of business than it has in the past. Physicians are engaged in joint ventures; and hospitals are competing with each other for economically profitable physicians and referral networks. But one change in practice that has perhaps touched upon Americans most pervasively is the introduction of managed care. The introduction of federal diagnostic-related-groups (DRGs) and, more recently, the