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Book and Media Reviews
August 24/31, 2011

The Hippocratic Myth: Why Doctors Are Under Pressure to Ration Care, Practice Politics, and Compromise Their Promise to Heal

Author Affiliations

Author Affiliation: Psychiatry and Biobehavioral Sciences, Harbor-UCLA Medical Center, Torrance, California (samsess@ucla.edu).

JAMA. 2011;306(8):883-884. doi:10.1001/jama.2011.1215

Physicians are required by the Hippocratic oath to act only in the interest of their patients. For most of the history of the oath, there was an irony in this commitment—because of the limitations of medical science, physicians could offer few real benefits to their patients other than emotional comfort. Sometime in the last 2 centuries this changed. Author Gregg Bloche dates the change to October 16, 1846, when surgery was first performed with the patient under anesthesia. As that breakthrough was followed by the introduction of sterile technique, radiography, antibiotics, and countless other technological innovations in the latter half of the 20th century and—not least—by the introduction of health insurance, health care emerged as a powerful professional and economic force in society. The increasing power and authority of medicine generated a cycle both virtuous and vicious, with new problems as well as opportunities that Hippocrates could not have anticipated. For example, patients might insist on expensive, high-technology medical care, typically financed by insurance, while their physicians are offered financial incentives to cut spending by limiting the provision of such care. The expanded range of options for addressing conditions once considered “normal,” such as short stature, has produced a debate about when and whether such care constitutes treatment and is therefore obligatory under the oath or instead falls outside its scope.