If I Betray These Words

Author’s Note The deadline for choosing a title for this book arrived unexpectedly as I was deep in writing chapter 6, which is about a doctor who takes his own life. In a flurry of communications with the publisher and editor that grew more frantic by the hour, we tried to distill the essence of the work to a word or two. The collected stories deserved exactly the right title, but despair about a flurry of imperfect ideas melded with the grief I was feeling about the character in chapter 6, and I was lost. As I often do when stuck in a morass, I paused and returned to the source document, so to speak -- to the oath we take as physicians, in its many forms. This oath represents what each of us believes is our duty to society in joining this profession and embarking on a lifetime of tending to strangers in their moments of greatest vulnerability and need. It is the commitment that calls us to be our best selves. I read the Declaration of Geneva of the World Medical Association, the Oath of the Healer, the American Medical Association Code of Medical Ethics, the Osteopathic Oath, the Maimonides Prayer, and many versions of the Hippocratic Oath. Similar themes ran through them all: gratitude toward teachers, a commitment to lifelong learning, an obligation to nurture the next generation, selflessness, one’s duty to patients above all else, honesty, humility, confidentiality, love. But when I discovered a 2010 translation of the Hippocratic Oath by Amelia Arenas, published in Boston University’s journal Arion, I found the title. This version of the oath echoes the themes of all the rest, but the last lines took my breath away: The covenant we make is not simply about how we will do a job, it is also about who we will be when we don the mantel of “physician.” It proscribes our conduct, calibrates our moral compass, and entwines both with our identity. Betraying these words, then, forsakes our identity, which can unmoor us and threaten our dissolution. In standing up to moral injury and fighting for our oaths, we are fighting for our patients as if our lives depended on it. Because, figuratively, and too often literally, they do. I am humbled by and grateful to all the medical professionals who have spoken up against their destruction, and to those who find the courage to do so in the future. Introduction – What Beer and Modern Healthcare Have in Common Dr. Mike Hilden answered the knock on his front door in the fall of 2012 to find two Federal Bureau of Investigation (FBI) agents waiting to speak with him. The FBI hadn’t come to Carlisle, a quiet college town of twenty thousand people in central Pennsylvania, for drug dealers or old-school racketeers. They were talking to doctors, nurses, and administrators at the local hospital, tipped off by whistleblowers who leveled fraud allegations at Health Management Associates (HMA), the fourth-largest hospital corporation in the US, and the owner of Carlisle Regional Medical Center. Dr. Hilden had been a hospitalist at Carlisle Regional for more than a decade, since before the board of the nonprofit community hospital sold out to HMA. Now it was one of seventy-one hospitals in a nationwide for-profit enterprise that was being accused of coercing physicians to forsake their medical judgment -- to hospitalize patients who didn’t meet insurance criteria, to order more tests than their conditions required, and to keep them in...

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Wendy Dean and Simon Talbot

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"Offering examples of how to make medicine better for the healers and those they serve, If I Betray These Words profiles clinicians across the country who are tough, resourceful, and resilient, but feel trapped between the patient-first values of their Hippocratic oath and the business imperatives of a broken healthcare system"--

Résumé
**FEATURES A NEW AFTERWORD BY THE AUTHOR

An incredibly important and captivating book for patients, families, and clinicians detailing how we’re all hurt by corporate medicine

“Wendy Dean diagnoses the dangerous state of our healthcare system, illustrating the thumbscrews applied to medical professionals by their corporate overlords… Required reading for all stakeholders in healthcare.” — Danielle Ofri, MD, PhD, author of When We Do Harm: A Doctor Confronts Medical Error

Offering examples of how to make medicine better for the healers and those they serve, If I Betray These Words profiles clinicians across the country who are tough, resourceful, and resilient, but feel trapped between the patient-first values of their Hippocratic oath and the business imperatives of a broken healthcare system.

Doctors face real risks when they stand up for their patients and their oath; they may lose their license, their livelihood, and for some, even their lives.

There’s a growing sense, referred to as moral injury, that doctors have their hands tied – they know what patients need but can’t get it for them because of constraints imposed by healthcare systems run like big businesses.

Workforce distress in healthcare—moral injury—was a crisis long before the COVID-19 pandemic, but COVID highlighted the vulnerabilities in our healthcare systems and made it impossible to ignore the distress, with 1 in 5 American healthcare workers leaving the profession since 2020, and up to 47% of U.S. healthcare workers now planning to leave their positions by 2025.

If I Betray These Words confronts the threat and broken promises of moral injury – what it is; where it comes from; how it manifests; and who’s fighting back against it. We need better healthcare—for patients and for the workforce. It’s time to act.