Sunday, September 10, 2006

Physician, Do No Harm

There is some argument about whether Hippocrates was born in 470 or 460 BC in Ancient Greece. But there is no doubt that he is the guy who came up with the Hippocratic Oath. That’s the promise that doctors have been making for over 2,500 years: to follow a professional code of conduct, to work for the good of their patients, to avoid violating the morals of their community, and to do no harm. That is, until the US Centers for Medicare and Medicaid Services got into the act.

It seems that this outfit paid out $275 million last year to get doctors to assess elderly Medicare patients’ reactions to chemotherapy. For an extra $130 per visit, reactions like pain, fatigue and nausea were included in the evaluation and then reported on. Apparently pain, fatigue and nausea assessments are optional extras; for an extra $130 your physical examination can be super sized! Unfortunately for the Medicare patients, their share of this cost was $26. Unfortunately for US taxpayers, the government’s share was $104. Fortunately for the doctors, the odd $130 can add up to more than a golf club membership if you upgrade enough of those bothersome office appointments to examinations.

About 90% of eligible health care providers went along with this idea and the average provider earned a cool $23,000 from the Feds for noticing that Mrs Goldfarb was in agony and throwing up in the waiting room before collapsing on the little practice putting machine in the office. The top ten noticers pocketed more than $270,000 and one Hippocratic heir in Kansas picked up $507,563. This would be a nifty idea if the results of all this noticing and assessing and reporting were actually worth anything.

Unfortunately, Daniel Levinson, Inspector General of the US Department of Health and Human Services reported “numerous gaps and anomalies in the data and collection methods”. In a strong defence of the medical profession, after reviewing the programme, the Congressional Medical Advisory Commission reported that “Most oncologists did not believe it would lead to quality improvements for patients or produce any useful research findings”. The Commission did not report on how many little practice putting machines were saved from irreparable damage.

All is not lost. After all, Bill Frist, (Republican-Tennessee) the majority leader of the US Senate, is a doctor and he can surely get to the bottom of this story. High ranking Congressional sources assure H I that Bill will use his extensive medical background to review this sordid tale as soon as he has convinced Tennessee not to lift his medical license. What with all the pressures of spending $275 million on gathering useless research findings and diagnosing brain dead Floridians based on looking at home movies, Bill has not had the time to meet the state’s continuing education requirements for physicians. As soon as the Senator wraps up his presidential campaign, there should be plenty of time to get caught up. In the meantime, there is a huge demand for his medical skills. The United States is full of people who are suffering from pain, nausea and fatigue at the thought of Senator Frist running for President.

Alas, there is no record that Hippocrates ever ran for public office. It would have been handy if he had come up with an oath that said Politician, Do No Harm.

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