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The Hippocratic Myth: Why Doctors Are Under Pressure to Ration Care, Practice Politics, and Compromise their Promise to Heal Hardcover – March 15, 2011


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Editorial Reviews

From Publishers Weekly

Bloche doesn't balk when it comes to laying it on the line. He gives readers the bleak news: insurers have the right to "pick and choose medical opinions," regardless of need, which puts doctors in an increasingly difficult position. In Bloche's first book, doctors are political animals (he argues that "diagnosis...is a political act") and moral questions abound. As doctors increasingly enter courtrooms to help determine child custody cases or mental competency, practitioners are also "moral arbiters and enforcers." And a "Doctors as Warriors" section offers a fascinating profile of "new" medical professionals but is dense enough to lose casual readers. Bloche's case studies, however, are particularly effective: a patient decides to stop dialysis knowing that it will result in her certain death; a soldier with "classic symptoms of PTSD" struggles to find coverage and competent care. What Bloche makes terribly clear is that the crisis we face encompasses medical care, coverage, and cost. He deserves kudos for taking on such disheartening, pressing subjects, for asking tough questions, and for finally offering dramatic reforms. This is a valuable look at the world of medicine. (Mar. 15)

Review

"Bloche writes with sensitivity and empathy not just about patients and physicians caught up in managed-care catastrophes, but about all the weird variations on the patient-physician dyad spawned by the expanding public role for medicine ... The empathy, sensitivity and care of his arguments are not surprising, given his background, but they are no less laudable for that." -- The Washington Post
 
"Bloche deserves kudos for taking on such disheartening, pressing subjects, for asking tough questions, and for finally offering dramatic reforms. This is a valuable look at the world of medicine.” --Publishers Weekly

"An intriguing examination of the moral and political dimensions of some of the most important medical issues of the day."--Sandeep Jauhar, author of Intern: A Doctor's Initiation

“In the Hippocratic Myth, Dr. Gregg Bloche offers a beautifully written, thoughtful, and compelling account of the many ways doctors today are called upon to compromise their adherence to the Hippocratic Oath while appearing to remain faithful.  Bloche looks at this cluster of issues in different contexts, from the covert rationing of care to use of medical skills in the context of lethal injections.  As a doctor and a legal scholar, Bloche knows firsthand what the tensions are. The Hippocratic Myth offers readers a series of vivid, sometimes heart-wrenching stories in the context of a careful portrayal of the challenges facing our health care delivery system.  Bloche’s account will appeal to a general public hungry for ways to make sense of doctors’ role within our health care system.  An important, subtle and powerful book.”—Elyn Saks, author of The Center Cannot Hold

“As Gregg Bloche argues so persuasively in this important new book, it is but a short distance from the Hippocratic Oath to medical hypocrisy.  In the contemporary world, where medicine so often finds itself enmeshed in multiple social, political, and industrial interests, doctors can no longer honestly promise exclusive devotion to their patients.  The time has come, Bloche powerfully demonstrates, for transparency and democratic debate about the hard choices we face and the future of professional ideals. “ --Allan M. Brandt, The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product that Defined America

“Gregg Bloche deftly tells real-life stories that capture medicine’s expanding public role – and its contravention of the Hippocratic promise of doctors’ ‘uncompromising loyalty’ to patients.  He may not have arrived at a precise definition of the ‘permissible ends of medicine,’ as he writes, but he pull us along much closer to one with this very thoughtful book.”--Susan Dentzer, editor of Health Affairs and former health correspondent for The NewsHour

 “Gregg Bloche’s provocative book deserves careful reading by everyone who cares about physician integrity and the social compact between doctors and patients."--Harvey Fineberg, President of the Institute of Medicine

“In The Hippocratic Myth, Gregg Bloche – physician, lawyer, and ethicist – guides the reader to acknowledge and accept the reality that doctors are agents of society as well as guardians of their patients.  Bloche skillfully weaves together an extraordinary range of stories and accounts of medical involvement in rationing, in war, even in capital punishment and torture, most of it based on his own research. “--Daniel Wikler, Harvard School of Public Health

“Confronting issues that policy makers commonly seek to evade, and building on his own experiences as a physician and attorney, Greg Bloche examines the many ways in which the Hippocratic ideal - that physicians serve exclusively as advocates for their patients- is increasingly compromised. Recognizing the inevitable economic constraints in doing all that medical knowledge and technology makes possible, he explores alternative frameworks for addressing conflicts of interest in more ethical ways. The questions explored are central to the future of an equitable and ethical system of health care and merit much discussion and debate as we go forward.”--David Mechanic Ph.D. Director and Rene' Dubos University Professor, Institute for Health, Health Care Policy, and Aging Research, Rutgers University

"Bloche draws the curtain back on the central tension in health care: we can do far more in medicine than we can pay for – and somebody has to decide what gets done.  Who should that be? Doctors try to hide behind their oath and claim they act exclusively in the interests of patients, but Bloche shows that this is a myth.  They are entangled in the economics of incentives and limits.  Physicians and patients alike will be disturbed, even angered, by this book.  That’s why they must read it."--Stuart M. Butler, The Heritage Foundation
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Product Details

  • Hardcover: 272 pages
  • Publisher: Palgrave Macmillan Trade; 1 edition (March 15, 2011)
  • Language: English
  • ISBN-10: 0230603734
  • ISBN-13: 978-0230603738
  • Product Dimensions: 6.5 x 1.1 x 9.5 inches
  • Shipping Weight: 1 pounds (View shipping rates and policies)
  • Average Customer Review: 4.8 out of 5 stars  See all reviews (5 customer reviews)
  • Amazon Best Sellers Rank: #1,125,919 in Books (See Top 100 in Books)

More About the Author

M. Gregg Bloche, M.D. is an award-winning health policy expert and a professor of law at Georgetown University. He has written for the New York Times, the New England Journal of Medicine, and other leading publications and has appeared on 60 Minutes, NBC, CNN, ABC, National Public Radio, and more. Bloche, who received a Guggenheim Fellowship to write this book, was a health care advisor to President Obama's 2008 campaign. He has also been a consultant to the World Health Organization, South Africa's Truth and Reconciliation Commission, and other governmental and private bodies. Bloche has taught or held appointments at Columbia, Harvard, UCLA, and the University of Chicago, as well as the Brookings Institution. He is a graduate of the law and medical schools at Yale, a member of several editorial boards, and the recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy. Bloche lives in Washington, D.C.

Customer Reviews

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Most Helpful Customer Reviews

11 of 11 people found the following review helpful By Lindsey on March 16, 2011
Format: Hardcover
Hippocratic Myth is a completely fresh take on the healthcare debate in America. Gregg Bloche lays it all out in really engaging stories of real people who face the "quiet hypocrisy" of doctors rationing their healthcare for them because they are under such intense pressure from their employers (HMOs, hospitals) to keep costs down. One woman couldn't get her healthcare provider to cover surgery for her endometriosis and another woman was sent away from the emergency room even though she had a brain aneurysm.
The book also has the best explanation of doctors' complicity in Enhanced Interrogation Techniques developed by the DoD. Lots of great reporting and a really fast read. I highly recommend it!
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7 of 7 people found the following review helpful By romy on March 21, 2011
Format: Hardcover Verified Purchase
The Hippocratic Myth articulates, in an honest and engaging manner, the practical realities confronting doctors which force them to veer from the ideal of the Hippocratic Oath. One heretofore unspoken truth is that doctors are silently rationing care, and Bloche brings this to light with case studies of real people facing the limits of medicine and the health care financing environment. In an interesting twist he points out that many of us are unwittingly consenting to the rationing of our own health care via our health insurance choices. At a time when health care costs are consuming ever greater proportions of national resources, this is an important book for health care consumers and providers alike to read and debate. It offers thoughtful insights on the way forward.
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7 of 7 people found the following review helpful By Diana Keeler on March 16, 2011
Format: Hardcover
Gregg Bloche sheds much needed light on the most frightening realities that beset 21st century medicine. His book gives name to some of our biggest concerns, as parents, as sons and daughters, as Americans, and admits that we have reason to fear. But it also opens the door for real discussion, real change, and real societal progress we can't avoid by imagining our problems away. Doctors are endangering patients, veiling moral choices behind the language of science, and, at times, compromising our liberties. Bloche courageously tells us how and why, and issues a new challenge to the medical profession, to patients, and to society: Let's develop a new, realistic compact between medicine and society - one that works for the world we truly live in, in this millennium.
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4 of 4 people found the following review helpful By Richard Scott on May 5, 2011
Format: Hardcover Verified Purchase
Having heard the interview and review on radio, I bought this . The best part is the discussion of the need for patients and physicians to work together for the control of medical costs and to do this through candor. The discussion of the post traumatic stress disorder and the difficulty in obtaining essential medical care for our soldiers is heartbreaking.
Unfortunately the subject is not political but a significant part of the book is politically motivated. Until we all realize that how we as a nation approach health care is not a party related direction we will not move forward.
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4 of 4 people found the following review helpful By JK on March 16, 2011
Format: Hardcover
An important and revealing discussion of the issues doctors face and the roles they play. The author uses vignettes about real cases which makes it a an engaging read. The book is not a polemic about health care reform, but a balanced look at the real dilemmas that need to be discussed candidly and addressed if we are move forward as a country. Highly recommended.
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