Hightower Lowdown

Medical ethics go back nearly 2,500 years to the Hippocratic Oath, which established a standard of behavior for doctors, including the admonition that they should do no harm.

Doctors still swear this oath, but the executives and beancounters of HMOs do not— and it shows.

In today's corporatized medicine, patients are referred to as "cost units," and the doctor is an assembly-line worker who must hold down costs by rushing "units" through the system, providing only as much care as the corporate manual prescribes. One doctor told the New York Times that his HMO expects him to see eight patients an hour—that's seven minutes with each patient before shouting, "Next!"

Another physician, Dr. Thomas Self in San Diego, is proud of his reputation as a thorough and careful children's doctor. When HMOs took over, however, Dr. Self's thoroughness got him fired—they said he spent too much time per child and ordered too many tests to find out what ailed them. According to Dr. Self, the HMO executives did make exceptions to their usual rush-rush procedure—when they sent their own children to see him. "In two instances," he said, "I was told to do whatever was necessary, with no thought given to cost, by the executive whose children were being treated."