The Hippocratic myth : why doctors are under pressure to ration care, practice politics, and compromise their promise to heal /

This book by Bloche (law, Georgetown Univ.) should open eyes. It argues that expanding social pressures and obligations on medicine, including stewardship of scarce resources, providing expertise in criminal justice matters, and supporting national security, create serious tensions with the Hippocratic promise to stand by the sick. Case studies demonstrate the problematic complexity in distinguishing useless from life-saving and improving treatments, as well as specifying clearly the nature of such "diseases" as PTSD and their proper treatment. The upshot is that medicine and society must quit denying that "all medical diagnosis" is political--making judgments about what is undesirable, what is beyond one's personal responsibility, and what counts for resource investment. Testifying in court concerning competence, disability claims, and child custody, and participation in executions, puts doctors into quandaries about the boundaries between social duty and Hippocratic fidelity. The involvement of doctors in the Abu Ghraib interrogations under the guise of a nontherapeutic role further strained the conflict between fidelity to patient and social obligation. This book makes clear the need for society and medicine to clarify limits on medicine's public role. Summing Up: Recommended. Lower-level undergraduates and above; general readers. J. A. Kegley California State University, Bakersfield

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) © Copyright PWxyz, LLC. All rights reserved.