Organized American medicine would like for physicians to “speak with one voice.”
If they could do so, and if that voice were in the public interest, not only in the self-interest of those physicians, it would be a very powerful voice indeed.
Arnold (Bud) Relman, the esteemed former editor of the New England Journal of Medicine, once rightly told the International Committee of Medical Journal Editors that physicians speak with many voices. Would you believe more than 1,000 000 in the U.S. alone?
For 30 years, my job has been to listen to those voices, and to respond to or further distribute some of them. For the last 15 years, it has been a lot easier because of the Internet.
Many physician discussion boards, open or closed, anonymous or named, post unfiltered comments on a host of issues, providing valuable insights into physician thinking.
On July 5, 2011 we published my column entitled “Wanted: American Physicians With Courage.” lamenting the failure of American physicians to move from PCI to intensive medical therapy for patients with stable coronary artery heart disease after the data became clear.
On July 6, 2011, Dr. Richard Faiola, a board certified family physician from Olympia, Washington, whom I do not know, posted a responding comment.
I found Dr. Faiola’s comment to be so well written and so representative of what I hear from so many voices of American physicians in 2011 that I republish it here in its entirety:
“It is not only greed by my cardiologist colleagues or laziness on the part of we PCPs. The ‘standard of care’ — defined as ‘what everybody else is doing, right or wrong’ is a very difficult thing to go against. So is the prejudice of Americans to DO something.
“If I, with no effort at all, send such patients immediately to the cardiologist, they may come back convinced their life has been saved and I am a hero for having sent them on. If they still have an MI or die, ‘at least we did our best.’
“If I take 10 minutes in a busy day to explain to a patient why they do not need to be placed on the cardiology treadmill leading at minimum to several expensive studies and likely PCI and they have their MI or die — I will almost certainly have the opportunity to explain to 12 persons by no means my peers the statistical models and physiological nuances of meta-analysis and cardiovascular disease to justify my ‘having done nothing’ to prevent that outcome.
“How many of my local cardiologists (who have been stiffed for months or years by my reduced referrals) will be running to my defense. Giving the patient personal financial skin in the game (i.e., Heath Savings Accounts) and Tort Reform are the ONLY ways to bend the ‘cost curve.'”
Dr. Faiola speaks for himself. I am sure that his points are heartfelt, sincere, and widely held by many other good people. In my view, they are understandable and both sociologically and historically sound.
A point-by-point discussion and refutation of each is beyond the scope of this short column, but many of his points already have been addressed in earlier columns and will be addressed subsequently.
I consider virtually all of his points to be scientifically incorrect and to serve the interest of the physician(s) rather than to serve the best interest of the patients or the health and well-being of the public.
How common, how true, and how sad.
At stake is nothing less than the question of whether American medicine is a scientific profession or is based on short-term, bottom line, MBA-type reasoning.
George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.
Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.
