Commentary—

The Hippocratic Method vs Managed Health Care Method

By George C. Anderheggen, PhD

Before 1946 an interesting article was published in The Practical Cogitator by L.J. Henderson regarding the methods of Hippocrates. In the appendix of their book Security Analysis, by Benjamin Graham, Warren Buffett’s teacher (remember Buffett is the second richest person in the world) and David L. Dodd set forth the method used by Hippocrates as follows:

“The first element of that method is hard, persistent, intelligent, responsible, unremitting labor in the sick-room, not in the library; the complete adaptation of the doctor to his task, an adaptation that is far from being merely intellectual.

“The second element of that method is accurate observation of things and events; selection, guided by judgment born of familiarity and experience, of the salient and the recurrent phenomena, and their classification and methodical exploitation. The third element of the method is the judicious construction of a theory — not a philosophical theory, nor a grand effort of the imagination, nor a quasi-religious dogma, but a modest pedestrian affair, or perhaps I had better say, a useful walking-stick to help on the way — and the use thereof.”

Henderson felt that security analysts should follow these principles when checking out companies and recommending them to their clients.

The methods suggested by the great doctor Hippocrates seem in complete juxtaposition to managed health care. The words and practices of MHC are not in step. MHC talks the talk but does not walk the walk. They have taken a profession and turned it into an industry. They take no oath to other than the bottom line of the financial report. I wonder about the oath of the medical profession. I do not know if the medical profession really stands and says the solemn oath of Hippocrates at the end of their training as we used to do in school as children when we pledged allegiance to a flag that represents the USA. As a psychotherapist, the only place I took that pledge was in my heart. That is not good enough in my opinion. It should be part of every graduation; a requirement of membership into any health care organization. The only problem is that oath is in conflict with MHC’s bottom line.

Consider six or eight sessions to cue whatever is presented to the therapist. How about more paper work to get more hours to see the individual? How about a call to MHC for approval before you even start treatment? How about written reports on how you are going to take care of this matter before you really have a grasp of the matter? How about naming the problem almost before you have enough data to even partially know the individual? Some therapists have moved the therapeutic hour to 50 minutes, then to 45 minutes and then to 40 minutes in order to do the notes and paper work necessary. You may say, why not hire someone to do this for you? Consider the added cost when MHC has a fixed rate for the therapist and also consider client/patient confidentiality. We have lost a profession, the health care profession, and gained an industry. What used to take care, kindness, knowledge, experience, and love now takes the business approach to the bottom line. This is not the bottom line of health, both physical and mental, but rather the bottom line of money and greed. It has been said that you cannot serve two masters. Managed health care knows that and they are doing what is right for an industry, but the health care professional has allowed himself or herself to get caught in a trap between money and care. We serve two masters, health and money.

What is wrong if you need the session to be longer for individual A? What is wrong with fewer sessions in a day so that you can think about individual A? Why is our country one of the few that panders to the wealthy and overlooks the poor members of society? How did we allow ourselves to stop living by the Hippocratic Oath in our health care profession and sell ourselves to managed health care? How can security analysis focus on this methodology of Hippocrates while health care seems to have sold itself into the slavery of industry?

I have been asked why I am not a provider for MHC. Here is why. If I need to charge less or more I can. If I need more time to see an individual, I don’t have to jump through hoops to get that time. If a person comes in who is suicidal, I don’t have to listen to some person on the other end of the phone tell me they can only approve one session. Yes, it did happen. My client’s/patient’s confidentiality is far better protected. I am not spending hours filling out paperwork to keep MHC in business. I do not need to spend hours on the phone pushing buttons to get someone to tell me what other paperwork they need to justify the claim.

Frankly I want to be a health care professional, which means following the Hippocratic Oath, not a health care provider, which means being chained to the bottom line of industry. I don’t want someone in some far-off location deciding what my client/patient needs or can have when that far-off person has not spent even ten minutes with the individual.

I choose to live by the Hippocratic Oath even though I never had to stand up and pledge allegiance to it in a public ceremony. Maybe all health care professionals should have to take the oath once every year just to refresh our memories. There is a point at which health care professional must choose between the health of the people we purport to serve and out bank account.

(George C. Anderheggen has been a marriage and family therapist in Connecticut since 1972. He lives in Monroe.)