The Economics of the Hippocratic Oath

When we discuss healthcare economic principles with patients, we build upon their trust in us.

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“I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.”

This portion of the Hippocratic Oath encourages that we recognize that illness has far-reaching effects on our patients and their families. Illness threatens their ability to support themselves and their dependents. This financial uncertainty often occurs suddenly and with little time for planning or preparation. By acknowledging these secondary circumstances, we have an opportunity to strengthen the doctor-patient relationship.

Such economic uncertainties have existed since the earliest versions of the Hippocratic Oath. How do we take this patient insight to an even higher level? We must continue to evolve — as the economic realities facing patients today, just like medicine itself, are evolving. In addition to worrying about their jobs, income, and time away from work, patients must also understand and deal with insurance coverage, deductibles, copays, and pre-authorizations. They must also consider quality, outcomes, clinical pathways, and patient experience. And they, like us, must also consider new and innovative concepts, such as digital medicine, digital therapeutics, and AI. For the newly diagnosed, terms, acronyms, and concepts surrounding their disease are unfamiliar; so are many economic terms. All of this can create large information gaps. As physicians, we are well positioned to fill these gaps. We have the trust of our patients and society in general. We have the credibility borne out of years of training and experience. And most of us took the oath.

To use economics to strengthen our relationship with patients, the requisite economic base should not be viewed as a separate component of the care we provide. Such concepts and discussions are not separate from the art and science of medicine described in other parts of the Hippocratic Oath. They are complementary. When we understand, communicate, and discuss healthcare economic principles with our patients, we build upon their trust in us. Imagine that we are discussing our diagnostic and therapeutic plans with a patient when the following questions arise: “Doctor, what does this five-digit code on my explanation of benefits mean? Is that procedure covered by my insurance? And what are all these coverage requirements?” Our ability to answer, or at least attempt to answer, such questions (within the context of our broader healthcare discussion) is yet another opportunity for us to connect. It takes the doctor-patient relationship to a higher level. It makes us more valuable.

The task of engaging our residents, fellows, and new physicians in healthcare economics falls not only on our training programs but also on the ACR. We can also engage with our young physicians as they enter practice and find themselves introduced to the realities of business and healthcare economics. And we cannot forget practicing radiologists who are equally eager for updates on the innovations before us.

To uphold certain ethical — and economic — standards is a personal challenge. Perhaps in the future, we will find ourselves on the other side of the discussion, as patients, and look to our physicians for information and answers. Understanding the potential economic consequences of illness is a continuum of care worth embracing and an important opportunity for our entire profession. Integrating relevant and meaningful conversations into our patient interactions satisfies that very personal pledge most of us took the day we became doctors.

 By Ezequiel Silva III, MD, FACR, Chair

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