Mark J. Lema, M.D., Ph.D. Editor

A Public Betrayal

A 35-year-old manager of a carpet store arrives home at 8 p.m. in time to eat his reheated meal and visit briefly with his children. His wife, whose day started at 6 a.m., is in the process of preparing their two children (ages 6 and 9) for bed.

Suddenly he hears a crash, a scream and a thud coming from upstairs. He bounds up the steps to find that his 6-year-old daughter has fallen off a chair reaching for a glass and hit her head. She now appears dazed and somnolent. In a panic, the parents grab her and the other child and rush to the nearest emergency room at their regional hospital.

What happens next depends on where you live, if your state, city or region is tort-friendly and if there is an ample supply of specialists to respond in time to avert irreversible injury. You may wonder what is so novel about this scenario since we have been inundated with media admonitions about limited access to health care, the vanishing specialist and the disenfranchised physician phenomenon.

It seems that physicians are making threats to “strike” or, euphemistically speaking, to participate in a work slow-down. This form of striking can be disguised as a rally where all physicians leave town for a day to petition the government or to attend a national conference. The end result diminishes or eliminates timely services for urgent or emergency care and places innocent citizens at risk.

On the day of our medical degree conferral, we took a ceremonial oath to care for the sick and, “above all, do no harm.” Throughout our residency training, we learned that medical errors were divided into two large categories: “sins of omission” and “sins of commission.” We were taught to medically care for or transfer care to another provider and never to abandon the patient. However, there were never any clinical pearls to suggest how to refuse care for the suffering. Why? Because that notion was unconscionable and unethical.

The era of business and legal control of medical practice has systematically dismantled health care. It is now impossible for many physicians who work in high-risk specialties to simultaneously care for patients, to receive reduced payments and to pay tripling malpractice insurance costs. Thus, doctors who can, run; those who cannot, fight back. In desperate times, draconian measures are employed. To withhold medical care for even one day, however, is a betrayal of the public trust placed in those who took an oath to practice medicine.

Consider an analogous situation, which prompted a citizen to write a letter to our local newspaper. When contract negotiations between the mayor and police union broke down, the union officials told officers to strictly enforce the law. As a result, roadblocks were set up on busy thoroughfares, and citations were being written for minor infractions. Of course, the timing for such roadblocks occurred just prior to a major sporting event and during rush-hour traffic. Citizens missed picking up children from school and were late for appointments, work and the game. Widespread frustration and criticism was heard around the city, and support for the mayor soared.

One woman wrote to the Buffalo News, chiding the officers for being so selfish. She commented that they had well-paying civil service jobs with guaranteed health benefits. She pointed out that a number of the citizens who were “collateral damage or pawns” between the city and the cops earned considerably less and had no health insurance. As the person stated: “We’re just hard-working people who trudge through the day.” She finally summed up the collective opinion of the community with her closing remarks:

“If the police feel that making a point to the city by systematically provoking the citizens will gain our support, think again! We expect police to protect and serve … If [they] are unhappy… do what we do: get another job!”¹

I can see many similarities to this police scenario and the increasing threat of work stoppages and slow-downs by medical professionals. Physicians will lose the respect and trust of the public if citizens become “collateral damage” in the war against medical regulation and diminishing payments. While I also commiserate with my colleagues who are faced with insurmountable practice costs, it is unwise and unethical to unintentionally hurt the public as a means to emphasize the intensity and immediacy of our reimbursement crisis. Our only solutions are to quit medicine, run to a safer haven (Aruba?) or unify in our effort to reform health care.

Doctors, unlike colonial farmers and merchants, scatter instead of unifying in times of external crisis. The American Medical Association (AMA) and all of the specialty societies need to unite, to speak as one voice irrespective of personal interests to change the current paradigm of medical practice in America. While this effort is slowly coalescing, it needs some catalyst to expedite our formation of one national voice, our establishment of one “trade union” and our preservation of high-quality, affordable and accessible medical care for the welfare of our patients.

When you feel suffocated by the perception that the forces of evil are controlling or restricting your ability to care for your patients and to earn the living commensurate with your knowledge and skills, do not drop out and tune out. Become an “army of one,” and help AMA, ASA and your state societies and/or county societies fight for this cause in the halls of Congress and your state capital. It is not just about (political action committee) money anymore; it is about our professionalism and your patients’ well-being. Let us not become betrayers of the public trust by engaging in egocentric thinking. Conversely, let it be the physicians carrying the standard of both high-quality health care and adequate compensation to achieve meaningful and effective access for all citizens. After all, as one Buffalonian stated in regard to the average citizen, “We’re just hard-working stiffs who trudge through the day.” Let’s not add to their burden by scaring them with the threat of no medical care when they need it.

– M.J.L.