HIGHTOWER: HMOs Muzzle Doctors

Hipocrates wrote the ethical guidelines that for centuries have governed how doctors relate to us patients, beginning with that reassuring dictum: "First, do no harm."Ah, but the Hipocratic Oath is old stuff now that Wall Street and Washington are conspiring to "revolutionize" medicine. They're shoving doctors and patients alike into giant health maintenance organizations -- erecting a wall of corporate bureaucracy and profiteering between you and your doctor. In this Brave New World of corporatized medicine, the Hipocratic Oath has been replaced by the HMO Oath: "First, do no harm -- to the company."Kaiser, US Healthcare, Choice Care and other HMO chains prohibit their physicians from even discussing a treatment you need if their company doesn't provide that treatment. They also prevent an HMO doctor from sending you to a specialist outside the company, even if the doctor thinks the outside specialist would give you the best care.Nor are these HMO doctors allowed to tell anyone about special financial incentives in their contracts. Some HMOs pay bonuses to doctors who save the company money by refusing to authorize tests or treatments you might need, while other HMOs reward doctors who send you to in-house labs and specialists for costly treatments you do not need.These insidious contracts also prohibit doctors from making any negative remark to us patients about the quality of care we are getting from our HMO, even if the doctor decides that the HMO's policies do us harm. And if doctors leave an HMO, they are not even permitted to let their patients know why they left or where they are going. As one critic puts it: "[This] is more like managed silence than managed care."The muzzling of our doctors is just the beginning of the horrors you can expect from a system of fastbuck medical chains that inevitably put the profits of the company over the health of patients.

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