Physician integrity


Category : Medical Rants

A long time reader asked me to comment on this article – Wisconsin's Real Doctors and Their Fake Sick Notes for Protesters

Here is the real issue.  We are asked by patients to provide permission or medications on a regular basis.  Almost everyone accepts our word on patients' health status – insurance companies, employers, schools, etc. Our word helps patients receive disability status, including special parking places. Rarely does someone question our prescriptions (other than opiates).

What these doctors in Wisconsin have done undermines how everyone views physicians.

As physicians we have a right, and the same responsibility as any citizen to have and make public our political views.  We can lobby; we can protest; we can write letters to the editor.

But we do not have the right to manufacture medical information.  We have a sacred trust with society.  We should assess each patient the same regardless of politics.  To write sick excuses for protesters harms that trust.

Regardless of the political issue, these physicians did the wrong thing

After viewing the videos at my request last night, Dr. Arthur Derse called me up exclaiming, "Holy mackerel! It's much worse than it looked in the paper. I'm stunned, absolutely stunned." Dr. Derse is the Director of Center for Bioethics and Medical Humanities a the Medical College of Wisconsin. "When all's said and done, it's really the profession of medicine that has the black eye in this case," he says.

There is no question these doctors are masking political opinion in the white coat of the medical profession, Dr. Derse believes. "The videos are pretty damning."

Comments (9)

[…] This post was mentioned on Twitter by Robert Centor, Old doc KJ. Old doc KJ said: RT @medrants: Medrants: Physician integrity […]

Good argument for doctors separating their professional roles from their political beliefs.
A little is OK but too much and you corrupt yourself and your profession.

"We have a sacred trust with society. We should assess each patient the same regardless of politics."
It's a stirring speech, DB. Tell me: back in February of 2003, when doctors in New Jersey closed their office doors as a sign of protest against rising malpractice premiums, how was that not a violation of the "sacred trust" about which you presume to lecture some physicians in Wisconsin? In your posts at the time, you write sympathetically about those doctors, and not once do you seem to wonder if maybe this particular form of protest is unbecoming for a physician.
How is this not a double standard? Before you point out that the actions are different, note that I am referring to the double standard of this "sacred trust" that I've heard so many of my brothers and sisters blather on about in recent days re: the protests. Apparently telling patients to go Shove It because of some financial disputes doesn't constitute violating any trust at all, but what they did in Wisconsin calls for a Sunday sermon. I find this puzzling.
Normally a fan, but not so much today, Billy

Well, one is lying. The other is a business decision.

"Sacred" was db's word. Typically that implies a relationsip above mere business concerns; thus I'd argue that it matters not a whit that one is a case of lying, while the other a business decision.

Arrangements were made for all patients who needed urgent or emergent care to have access to care in the case of the NJ docs. 

I was aware of this, and I wondered if someone was going to bring it up.
Let me make sure I have the logic of your implication straight. Recall, sacred is the operational word here. So an office visit, if it's routine, is not sacred, while "urgent or emergent care" is sacred. That seems to be what you are arguing.
I suspect patients would not be enthusiastic about such distinctions. 

The "sacred trust", as it has been described in this discussion, involves how physicians conduct themselves within the realm of the physician-patient relationship.  The trust — sacred or otherwise — does not compel any physician to actually enter into a physician-patient relationship; that action is up to the individual physician, either by virtue of the role in which that physician is employed (e.g., an emergency room physician is held to EMTALA standards, but made a voluntary choice to become an emergency medicine physician in the first place), or by the physician's willingness to take on new patients (as in the case of the New Jersey physicians with office practices).
People, whether they be patients or not, may not be enthusiastic about such distinctions, but that does not make the distinctions any less accurate or applicable.

Post a comment