With the evolution of medical science and medical care intertwined with medical business, braided changes in medical regulation is not an far off expectation. But reticulation of evolution to modern medicine and health care has not happened in isolation. Simultaneously there has been progressively complex emerging trends in medical business and changing patterns of health investments along with an era of corporate investments in health care has also ushered. Every one now wishes to live longer and dreams of better quality of life with support of progressive medical care. Opportunities projected by advancements in health care, have shown that these dreams can be a real possibility, in many cases. That kind of perception has given patients a hope in lieu of some money. With rich people willing to spend more, the insurance sector and corporate invested money into health care, which was unthinkable few decades back in the past. This reticulation of business and health care really took away the profession from control of doctors. As it is no more simply treating a disease and involves many more issues. New model of business in health care is still not a mature process. It has emerged and progressed in just for few decades, as compared to medical treatments and systems that existed since ancient times. It is still in infancy and still has to go a long way to do real justice to every one. No one really knows how to regulate this difficult area, which encompasses life and death, deals with extremes of poverty and riches, mortality and morbidity, pain and relief , sadness and happiness, smiles and sorrows and uncountable emotions, intertwines with financial aspects. Most difficult part is amalgamation of intricacies of science with minds of patient and doctor’s skill in newly evolved milieu of financial complexities. Results are not encouraging for the profession.
An effort to govern or regulate the medical profession is not new. Hammurabi had initiated to write the rules of the game. This single professional species was managed with cruel regulation 5000 years ago, that initiated a change in the global perception and regulatory system in radical and unprecedented ways.
Hammurabi, 5000 years ago, was not even at the doorstep of medical science, but he promulgated some rules. It is difficult to say whether he was naïve or brilliant enough to make it more mathematical. He fixed heavy prize for saving lives and used to cut the hands of physicians for death or untoward incident. But he was still wise enough to pay heavily if life was saved. After thousands of years, with some scientific advancements, our regulation has remained more or less similar in basics. It is still based on principles of revenge and punishments. Now clearly knowing well the limitation of medical science and the uncertainties and complexities of human body in better way, it still remains somewhat unfair to doctors. In other words, it has not attained enough evolution and maturity.
Hammurabi at the start of civilization believed that doctors needed to be punished in case there was poor prognosis. He failed to understand the complexity of human body and the limitations of medical science, most of which was unknown at that time. By an application of average wisdom, doctor can be easily blamed for poor outcome, because he is always a common link between treatment and poor prognosis. Stricter punishments were imposed to regulate medical profession, even when the medical science was not even developed enough to deal with most of diseases. Children are always taught in school that medical profession is a noble one. But they are never told, about the cruelty this profession has faced since ancient times. Almost universally, the earlier work or contribution of a doctor to society is not taken into account. Even for complexities of medical science and uncertainties of the outcome, blame can conveniently be passed on doctors by application of average wisdom.
Hammurabi’s Codex specified the harshest form of deselection of health providers possible. If the physician erred through omission or commission, his fingers or hands were cut off, immediately stopping his practice. Therefore, a single mistake can undo all the good work of past or the future good work that could have been accomplished. Problem here is that who can differentiate with certainty the real cause of sufferings of patient, a poor prognosis or a mistake. Such regulatory systems will dissuade other good people joining the profession, again resulting in further inhibition and flourishing of profession for the good. Obviously, harsher penalties will discourage a physician surplus.
Today the global system of medical regulation, is becoming somewhat similar, to those ancient regulations in terms of punishment and revenge. Differential payment system for health care also resembles the Code of Hammurabi in some respects. And this is despite the fact that now we are very well conversant with the known uncertainty and complexity of the human body and despite cognizance of the poor prognosis in many disease states.
In an effort to institute a well controlled healthcare, our society is in a way re-entering the realm of an ancient medical regulatory system. Certain aggrieved health care consumers may welcome a move toward harsh penalties in the name of justice and simply for revenge but we need to keep in mind the poor outcomes in complex diseases, limitation of science and of course the idiosyncrasies of the human body. Evolution of medical legal system and medical regulation has to evolve and mature, to enjoy benefits of medical advancement to the fullest. Fear factors and Impact of present legal complexities, on doctors is already on a par with that of Hammurabi era.