It is increasingly obvious that contemporary healthcare practice is less and less consonant with the traditional, mythologized vision of Hippocratic medicine that many people carry in their heads, and which some advocate is still the right model for the professions today. It is fashionable to bemoan the loss of this mindset and its attendant professional iconograpy (the kindly, white-haired patrician physician; late-night house calls; lifetime relationships between doctors and patients; etc.). At the same time, it is inescapable that financial pressures (among others) on healthcare practice have distorted every aspect of patient care without exception - from the patient/caregiver relationship to what treatments are offered and what treatment goals will be honored. This trend, along with other assaults on the Hippocratic model, forces healthcare into a new mold, and forces us to find new ways to solve problems for which simpler, traditional solutions are not adequate.

This may be a good or a bad thing. However, even those who reject the Hippocratic model - and I do - usually also reject an explicitly market-driven model of healthcare, arguing that health is a primary human good, and in many ways a social good, that should not be subject to market forces. So it is thought-provoking to see evidence that healthcare provision occurs in some ways in a “stealth open market”, in which unacknowledged market forces shape care delivery in ways that are denied by the providers who respond to those forces; it is equally provocative to see open advocacy for such practices. But these are issues we have to come to terms with.

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