229. Unity and friendship in the medical society is important.Never has the divide between the practicing work-a-day physician and the non-practicing ivory tower elite physician been greater. It is the cancer of our profession: quick to spread, difficult to contain.
The first, and in some respects the most important, function is that mentioned by the wise founders of your parent society - to lay a foundation for that unity and friendship which is essential to the dignity and usefulness of the profession. Unity and friendship! How we all long for them, but how difficult to attain! Strife seems to be the very life of the practitioner, whose warfare is incessant against disease and against ignorance and prejudice, and, sad to have to admit, he too often lets his angry passions rise against his professional brother. The quarrels of doctors make a pretty chapter in the history of medicine.
Sir William Osler On the Educational Value of the Medical Society, In Aequanimitas, 335-6.
But this should not surprise us. It is a recurrent theme in history, just as Osler was quick to remind us. But the ideal that Osler advocated for has disintegrated under political, financial and partisan agendas that covertly operate without transparency.
If nothing else, social media is helping expose this divide and its corrosive effects on our profession.
"Never has the divide between the practicing work-a-day physician and the non-practicing ivory tower elite physician been greater. It is the cancer of our profession: quick to spread, difficult to contain."
In a letter published May 2, 2006 in the Annals of Internal Medicine I wrote
"A continuing decline in professional stature and income, when coupled with deteriorating working conditions, makes the continued existence of internal medicine untenable. I am pessimistic that current political and professional interests will allow significant change to resuscitate internal medicine. Would it then not be opportune to draft an obituary for internal medicine and commission a requiem to its memory?"
Unfortunately I am saddened that we are both correct.
It is up to us, as practicing physicians, and stewards of our profession, to resolve the issues that divide us, rather than wallow in our own self pity. I believe we should start my reaching out to those who once cherished and revered us as their trusted advocates - our patients. We must reestablish that sacred relationship and use it to unite us. It is in that spirit that I undertook the task of telling the fictional tale of one surgeon's love affair with his profession and his struggles to defend it, revive it and renew it, despite the seemingly endless stream of obstacles thrown his way. The series "A Surgeon's Heart" is not yet complete, but it should be later this summer. If you are interested I invite anyone, not just physicians, to go to www.asurgeonsheart.com I refuse to accept the notion that we are defeated, and this is my way of fighting back against the destruction of the greatest profession in the world. I believe the battle is not over until WE say it's over.
Nothing is more emblematic of this divide than listening to one of the elite academic leaders touting the dramatic decrease in cardiovascular mortality over the last ten years as some sort of accomplishment of the bureaucracy that they or their professional society (read other elites) developed rather than a concerted effort of the grunts in the trenches. It is usually followed by the rigmarole that not enough patients are being prescribed statins, ACE I, beta blockers...whatever. Of course, the only way to improve CV mortality is more oversight with registries to collect all your data that will be reported to CMS so they can punish you accordingly. Did I mention that this unnamed professional society will collect untold sums from CMS for selling you out?
I would not be surprised if CMS pays our professional societies more for my data of PCI than what I am actually paid for the procedure.
With any luck, one of our professional society CEOs will be appointed a high rank in Hillary's cabinet hence we should pay her $250k for an hour long talk.
You aren't going to want to hear this, but I will post anyway. Physicians who get too enamored with the dignity of the profession have always created a weakness for doctors generally. The only way to combat the bullying is to organize. Yet, that is the last thing physicians will do. There is no history of any group gaining power without organization. Unfortunately this means seeking the protection of a union. This is the last things docs will do and hence they will be squeezed and punished individually. The squeaky door gets the grease and that is just the way society works. Cooperate and be nice and you will be kicked around, with all the high sounding protests. We do not have a system based on right, or any moral imperative. We have a system which responds to outright protest. When physicians learn to invoke the protection of the Sherman atti trust act, and not before, they will be able to have some sway. I wish it were different, but no one can find an example of the opposite. Selma did not happen on principle, but on the open protest. I am an M.D. J.D. I wish every doc was.
I would make one minor change to quote:
"non-practicing ivory tower elite physician, hospital administrators and bureaucrats"
Well said, I agree unreservedly.
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