The Medical Society  2/95

by Del Meyer, MD

There is nothing more odious than the majority; for it consists of a few powerful leaders, a certain number of accommodating scoundrels and subservient weaklings, and a mass of men who trudge after them without in the least knowing their own minds. Goethe

During the early part of every year as we get to know our new officers, directors and generally get organized, the Journal focuses on the Medical Society and what organized medicine is all about and whether it serves any useful purpose. Apparently a significant opinion is that "it may be a draw." Some societies, as well as the state associations, have had major attrition in recent years while some, such as ours, are maintaining their numbers. In talking with a large number of doctors during the past year from this vantage point, however, many of the members are dissatisfied, and many former members felt they were not heard. One member of the editorial committee wrote an article in which he resigned pulling the article only just before press time.

Many feel that the society, and by extension the state association, takes positions on issues with which they don't agree. The members may then feel compromised by paying dues to an organization which doesn't support their point of view. Although the dues are not excessive, to support a position financially with which one disagrees eventually causes one to wonder whether membership is appropriate.

Even taking a position that a majority of the membership supports may only be representative of one-third of the entire physician community. The Board of Directors, which is only one percent of our society, will have great difficulty reaching consensus--determining how the other 99% feel. When an official stand is taken on any issue, it may disenfranchise a significant percentage of the members. What did we gain from "organized medicine" supporting one senatorial candidate over the other when the vote was almost equal? Did we really need to irritate half of our members and lose relevance with half of the electorate? Losing a few percentages of our members on a regular basis, will continue an attrition that eventually makes our society a minority of physicians in the community and the CMA in the state. Since our profession represents less than one-half of one percent of the population, when do we become politically inconsequential?

What should be the agenda of our society? Almost all physicians with whom I've spoken during this past year still feel we must put our patients first. Thus every issue must always answer the question, "What is best for our patients?" When the pros & cons are discussed openly, the answers usually becomes apparent. If they don't, then simply publishing the pros & cons should be helpful for all concerned. This is being done to a large extent but perhaps not in the above context.

Physicians also felt that we should have full ability to evaluate our patients without third party interference based on full disclosures of costs, risks and benefits. How can we be held responsible for cost containment unless the costs are made available to us PRIOR to our ordering a diagnostic study or treatment program? Our patients require informed consent. Is it too much for us to require an informed practice cost environment?

Almost all physicians also stated we should help each other maintain a high level of care. Recognizing that none of us can keep up with even a fraction of the medical literature, all supported that readily available consultations and exchange of information among the members of the medical team on any seriously ill or potentially seriously ill patient should not be infringed upon by any third party. Very few object that this should be under the direction and control of the patient's primary or personal physician.

All physicians are, of course, interested in their own welfare. However, a large number felt if the above is adequately assured, our own welfare would seldom be in jeopardy. Since our welfare is really the business side of medicine, then the business code applies. Unless what we do is for the benefit of our customers (patients), we won't survive in business (practice).

Our societies must protect us from the intrusions on our practice whether from the government or various other organizations. If we espoused the above, we would put the issues into their proper perspectives and develop alliances. We must change from protecting the organizations (including the physicians in those organizations) that are attacking us to defending the physicians who pay their dues. All voting members should pay the same dues. We shouldn't give greater control of our society to blocks of physicians with an agenda. Solo practitioners have told me when groups get a preferred rate, the society can no longer represent them appropriately and they will drop out.

The recent expose' by the BEE in naming a number of doctors is illustrative. The articles stated that one in 49 physicians is practicing bad medicine which would be about two percent. The Director of the Medical Board of California (MBC) stated that at least 95% of doctors are practicing good medicine. Can any other profession match that record, he concluded.

The BEE article only listed several cases as due to malpractice. Most of their actions were based on reviews from other sources. Hence, the greatest threat to our licensure now is the larger liability from adverse actions of the MBC, hospitals, CLIA, Medicare, MediCal, HMO reviews and harassment claims. Our society has been very effective in making liability insurance available to us to protect us from our patients' lawsuits. The society should immediately began assuring us coverage by an insurance carrier of any and all liability claims against us, whether from our patients or any other source occurred in, or during the course of any professional activity. The hospital peer review doctors are the agents of the hospitals and should be covered by hospital liability policies, not ours. Each of us would do well to call our liability insurance carrier and request coverage for any and all such liability.

Our medical society, as well as the CMA & AMA, would do well to be cautious in asserting what is perceived as "majority" will. Working for our patients and protecting their primary and consulting physicians should unite us. Everything else should then fall into place. Other nonmember physicians may then seek us out to be a part of the organized health care team. The public may then look to us as the captain of that team, not the whipping post.