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Problems With the Profit Motive in Medicine

Medicine used to be a service profession. Florence Nightingale did not go to the Crimean War to make a profit. Neither did Clara Barton in the Civil War.

At the foundations of the profession, of course, is the Hippocratic Oath. That lofty oath says nothing about maximizing profit for shareholders. In fact, the injunction to "first do no harm" implicitly criticizes those who would base decisions about health care on factors that do not relate closely to medicine's healing mission.

Applying Ideals to Today's Reality

Is Hippocrates old hat in an age of managed care and for-profit medical providers? Martin Seinfeld, an attorney with Futterman, Sirokin & Seinfeld in New York City, is emphatic in his answer to that question: No!

To be sure, we live in a country committed to private enterprise. And it may no longer be reasonable to expect nonprofit organizations, such as hospitals run by church organizations, to play the role they once did.

But let's not deny the negative impact on patient care that cold-blooded management decisions made by hospitals and healthcare corporations can have. Many hospitals are constantly crunching the numbers, looking for ways to cut back on staffing. When there aren't enough doctors and nurses on staff to take care of patient safety, balls start getting dropped and patients get hurt by medical malpractice.

How do balls get dropped? A patient may get an infection, because hospital staff did not spend the time to wash their hands or sanitize a surgical instrument. Or a bad fall may occur, because there weren't enough aides to transport a patient safely.

Problems like these are the tip of the iceberg of a larger problem that goes far beyond the decisions of any particular doctor or nurse. That larger problem is compromised care caused by excessive commitment to financial profit.

The Future of the Profession

Atul Gawande, the noted doctor, medical school professor and New Yorker writer, is a forceful critic of the medical profession as it exists today. He argues that to reduce medical mistakes and improve the quality of care, health care professionals must communicate better as part of a team.

Addressing the graduating class this year at Harvard Medical School, he sounded a call for change. "[W]here people in medicine combine their talents and efforts to design organized service to patients and local communities, extraordinary change can result."

We live in a capitalist society. We do not argue that doctors and other medical providers are not entitled to earn a profit and a good living. But when profit trumps medical judgment, and a patient is harmed, that patient must have access to the Courts to seek justice and financial compensation.

A good place to start, in fostering the change Gawande envisions, is by improving patient care and reducing the incidence of malpractice, so that financial success can be obtained by medical providers while benefiting patients.

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