Thursday, October 16, 2008

A Hippocratic Oath for Disease Management Organizations Involved in Healthcare (or is it Health Care?!?)

The Disease Management Care Blog was alerted to this link by colleague Tom Wilson of the Population Health Impact Institute. It describes an article in the Harvard Business Review that examines the merits of a ‘Hippocratic Oath’ for business people. It seems some persons in the banking sector of our economy haven’t exactly been angels.

Regular readers of the DMCB are already familiar with the concept of the Oath, which was reviewed in some detail here. In the meantime, new visitors and readers of HBR are welcome to access the post gratis, print it out on glossy paper and place it on those coffee tables and lamp stands in your corporate waiting areas alongside all those other copies of the business journals.

The DMCB was right then, and it’s right now. Healthcare trumps “first do no harm,” while commerce stresses “buyer beware.” While some would argue tough luck when it comes to the mortgage mess, it can also be argued that the current market turmoil had its roots in a widespread unawareness, due to opaquely leveraged financial instruments, predatory lending and clueless mortgage holders. The DMCB isn’t sure that the fix is a do-no-harm ethos or that it is even possible in most business settings. Rather, it expects lawmakers and regulators to turn up the heat on trying to make things even more transparent. If buyers can be more aware, that’s not a bad thing.

That’s the banking sector. In the commerce of healthcare, however, there will always be the added tension between those who would require a high standard of proof before exposing patients to potential harm (including wasting time or money pursuing questionable outcomes) on one side and those who would operate our clinics, hospitals and disease management organizations in classic business-like fashion. The two points of view are not irreconcilable, and when they're not, some tension between the ‘white coats’ and the ‘suits’ is a good thing.

That’s why the white coat DMCB continues to argue that disease management organizations need to continue to show why they are not doing harm, and why usual business-standard transparency (especially in the current environment) is not enough.

But, think the business posture of the disease management industry isn’t that important? Well, ponder this critical issue: is ‘healthcare’ a word or should it be spelled ‘health care?’ Hillary apparently prefers that it be spelled health care. The wordsmith sleuthing DMCB has found that Barrons says yes to health care, while the Free Dictionary and Merriam-Webster say both are OK. The New England Journal of Medicine can't make up its mind and says yes and no. The AMA also seems confused here versus here. Is this a compounding faux pas, the coarsening of proper English or the natural evolution of a living language? What's next? Diseasemanagement? Patientcenteredmedicalhome?

Pending expert commentary on this controversy in written communication, this tempest in medical typing, this lapse in medical language - it looks as if it's up to the writer.

In the meantime, the DMCB has set Word to accept 'healthcare.'

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