Two Recent Views of Population Health

"We propose that devotion to the best medical interests of each individual patient be replaced with an ethic of devotion to the best medical interests of the group for which the physician is personally responsible. Physicians who compromise optimal treatment for one patient in order to do more good for other patients can still profess strong devotion to patient welfare. The shift from individual health to group health is consistent with the focus of many HMOs on the health of the populations they serve and with the basis on which HMOs and providers are increasingly being judged for quality of care."

Mark A. Hall, JD, and Robert A. Berenson, MD, The Annuals of Internal Medicine, March 1,1998.

"You cannot practice on the individual and serve the collectivity and be the equivalent servant of both at the same time."
Daniel P. Sulmasy, MD, PhD, lead investigator of a study of 1,549 young physicians regarding whether doctors should stay with the Hippocratic Oath to individual patients or move to management of health care resources for the collective good. "Physicians torn between two loyalties," Vida Foubister, American Medical News, May 15, 2000.

Results of Sulmasy's "Collective Good" Study:
17% - said it is ethically acceptable to use financial incentives to encourage limits on medical treatment
81% - said undivided loyalty to the patient had decreased over the past 10 years.
51% - said their own patients' trust in them had diminished during the past 5 years.