The noble art of the physician: Hippocratic or hypocritical oath?

The legal and medical professions often do not see eye to eye. In university, they argue over who has to work harder. When they graduate, the argument pertains to who earns more money, or who has the higher societal standing. Given my background in law, it would be prudent for me to refrain from expressing my opinion on the matter. So one can imagine the doctors' disgust at frivolous lawsuits brought about by lawyers seeking an outcome for their clients. "These lawsuits are unethical!" the doctors cry. We all know that doctors take what is called a hippocratic oath to always practice medicine ethically. Many people don't know that lawyers are bound by strict rules of professionalism and actually face disbarment should they contravene these sets of ethical rules.

It came as a surprise to me when I was referred to a New York Times article suggesting an overhaul of the malpractice system in the US. President Obama famously appeared five times on different broadcasting stations on a Sunday to further his push for Health Care reforms in the US. Studies have shown that the malpractice system had imposed additional costs on medical treatment because of doctors' fears of being held accountable in malpractice suits. The result is additional and unnecessary tests being ordered to cover their bases, and thus higher health costs for the American people. This is more commonly known as 'defensive medicine' and is estimated to cost the American people in the region of US$60 billion a year.

But would an overhaul of the medical malpractice system reduce these costs? Doctors are paid more when they do more. Of course the extra tests and procedures are good for their patients but it is also good for the doctors. Furthermore, it will help protect doctors from lawsuits. If doctors are negligent then they should be held accountable for their actions. In any case, it is their insurance companies which bear the costs of any settlements or damages imposed by courts. Who says these extra tests and procedures are unethical? It is in the patient's well being and it helps protects doctors from lawsuits, never mind that it also earns the doctors significant amounts of money. Doctors took an oath to act ethically at all times, a tradition that goes back to the 400BC, they would never act unethically.

So what is there to complain about malpractice suits? When a doctor is negligent and causes injury to a patient, lawyers are brought in to obtain reasonable outcomes for their client. If a doctor is not negligent, then there are no suits. It isn't the lawyers and medical malpractice lawsuits that impose the costs on the health care system, it is the incompetence of doctors who are unable to uphold their duty of care to their patients. The predicament was well summed up by the NY Times which wrote, "The goal, remember, isn’t just to reduce malpractice lawsuits. It’s also to reduce malpractice."

The situation is no different in Western Australia. Last month it was revealed that many doctors and nurses had exploited a salary packaging system aimed directly at benefiting health care providers. It was reported that several workers had claimed up to $100,000 from birthday parties, weddings and barbecues as entertainment expenses. Of course the hippocratic oath only applies exclusively to medical practice. Nevertheless, the Australian Medical Association (AMA) had the nerve to ask for an 'amnesty' to avoid harm to the Western Australian health system in general. That is, these health care workers should not be held accountable for their deliberate tax fraud (which in certain cases may be criminal) because it is in the general good for Western Australia.

The Australian Nursing Federation (ANF) was "appalled" by subsequent sackings that came as a result of these tax frauds. ANF State secretary Mark Olson said, "I know that in many cases with these nurses we're only talking a couple of thousand dollars." Only a few thousand? No apologies have been proffered by either the AMA or the ANF, in fact, it wasn't the doctors or nurses fault at all. AMA State president Gary Geelhoed said that people were not clear about what the rules were, and thus did not knowingly breach those rules. I beg your pardon? What about the person who claimed his/her entire income as a meal allowance? Ignorance of the law is no excuse.

What we have are health care workers intentionally exploiting systems created for the benefit (in the case of salary sacrifice tax systems) and accountability (medical negligence laws) of health care workers. Who bears the cost of their exploits? The tax-payers, higher medical costs, higher medical insurance fees and ultimately, less resources available for the development of infrastructure for the greater economy (which I might add, is facing the worst economic downturn since the Great Depression).