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Physician Professional Associations Are Not Ivory Tower Elites

“We can destroy ourselves by cynicism and disillusionment, just as effectively as by bombs.”

This observation, from the late, great British historian Kenneth Clark, could be a warning sign to the medical profession. Some of the more incendiary commentary in blogs, editorials, and medical publications today display the classic characteristics of cynicism, which is a profound pessimism accompanied by a deep distrust and even the disparagement of the motivations of others. Physician cynics not only direct their anger at the usual suspects – members of Congress, insurance companies, and government “bureaucrats”—but even at their own colleagues, including the leadership of their own professional societies.

Now, to be clear, I am not talking about principled disagreement and debate over the best policies or course of action, which is good and healthy. It is only when such disagreement becomes “personal”—assuming the worst motivations of others, even when you don’t personally know them—that it becomes the type of self-destructive cynicism described by Clark.

Take the cynics’ charge that the leaders of physician professional associations, including ACP, are living in “Ivory Towers” disconnected from the “real world” of practice, and that they “sold out” the rest of the medical profession by their actions. Really? Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Physicians Wary Of Healthcare Reform Models Intended To Save Primary Care

When I talk to internal medicine audiences around the country about the latest health policy flavor of the day – accountable care organizations (ACOs) – a typical reaction is skepticism trending toward cynicism. Many don’t quite get what ACOs are all about and certainly don’t want to be lectured about how they need to re-invent their practices. And they don’t buy the idea that ACOs will somehow save internal medicine primary care. The same can be said, perhaps to a lesser extent, about their reactions to PCMHs (Patient-Centered Medical Homes), P4P ( pay-for-performance), HIT (health information technology), MU (meaningful use), and the whole alphabet soup of other reforms being proposed to reform health care delivery and payment systems.

And who can blame them? Older internists have seen this all before, and the word has gone out from them to medical students and younger doctors not to trust policy prescriptions that promise to save primary care. Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Life In The ER: Never Judge A Book By Its Cover

The ER is a highly effective bottom-filter for society.  When you work in the ER you are in daily contact with the worst that mankind has to offer: addicts, sociopaths, criminals, and the many many varieties of personality disorders with which a loving God has imbued humanity.  I say this not as condemnation: they are my people.  I know them and accept them for who they are.  I am here every day to serve them in their various needs, from the heroin addict who is dropped off blue and apneic to the homeless guy who just wants his unwashed feet looked at.

One of the refreshing features of many members of the lumpenproletariat is their candor regarding their habits.  Sure, it’s by no means universal, but it’s entirely common for me to ask someone quite directly: “Do you use meth?” and have the patient respond in the affirmative and without the least trace of self-consciousness expand on the degree and nature of their drug use.  The hardest question for me to learn to ask without blushing was “do you ever have sex for money or drugs?” (And yes, I do ask that of both men and women, when it seems potentially relevant.)  But people on occasion forthrightly admit that they turn the odd trick to support their habit. Read more »

*This blog post was originally published at Movin' Meat*

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