The Voice of Medicine  2/96

by Del Meyer, MD

The VOICE of Medicine may be difficult to define. Opinions formally expressed (voiced) may not represent information perceived. Perceptions are oftentimes more related to the recipient's awareness, knowledge, insight, and capacity for comprehension, than to the actual words spoken or written. Thus the public's perception of what they hear, read, or see is quite variable and may not be predictable.

Justice Louis Brandeis (1856-1941) once defined a profession, in addition to being the whole body of persons engaged in a calling which requires specialized knowledge with long and intensive academic preparation, as having a code of ethics with service as primary and money as secondary. The reverse would put us in the same category as "professional" sports.

The medical profession's perception of what their organizations do is not uniform. If we define organized medicine as those medical organizations open to all members of the profession regardless of specialty or type of practice, only three come to mind. They are our local, state, and national societies, known as SEDMS, CMA, and AMA. Since some of these organizations represent only about half of all physicians, the perceptions within our organized profession and those on the outside are also quite diverse.

Our patients and the public are unable to differentiate the voice of organized medicine, the voice of specialty societies, the voice of academic medicine, the voice of each of us individually, but perceive this as a composite voice of all of us in the practice of medicine. We in organized medicine have a very difficult task to make our professional voice as one that is not only perceived as in their interest, but in fact is. This is not the time to cast aspersions, but to learn from our past mistakes, there are many, and chart a course for the future worthy of our professional stature.

The recent headline in the Sacramento newspaper which states, "AMA backs off on killing anencephalic babies for organs" is unfortunate. Likewise, a previous headline about the AMA making back room deals with the Republican leadership concerning what we get paid as well as eliminating some onerous lab regulations. The journalists were possibly reporting statements as actually made. But the public's perception is that these headlines represent the real composite voice of medicine. It is also the nonmember's perception of the voice of the AMA. How do we change that perception?

The CMA takes stands on numerous issues. They may all have professional, public, or health implications, but do we need to take a stand on so many issues? Having lunch in staff rooms with the rank and file members, it is evident that many different segments of our membership are getting upset with our various positions. It is important that we are aware that these differences exist. These CMA & AMA positions has caused some members to make inquiries regarding the current dues statements indicating that 25% is unrelated to our professional or public interest. Therefore, it should be regarded as personal or lobbying interest and thus is not tax deductible. One current member asked me if he could just send in the 75% related to professional and public interests since he didn't agree with many of the AMA & CMA positions. Obviously not. But it is a problem that has to be addressed.

The AMA & CMA certainly have very sophisticated and expensive political machines. We are always near the top of the big spenders in lobbying. This is widely known outside of the business professional community. I hear about it from the guy at the hardware store or at Sears or at the school board meeting. They will give me an ear full. So far I have been unable to convince any of them that the AMA or CMA has the patient's interest at heart. It has been said that our government representatives in congress and state houses no longer represent us and we are thereby forced to have lobbyist perform this function. But shouldn't we also be working on correcting that problem?

Recently Sacramento had a religious crusade that attracted larger crowds to the Arco Arena than any major league sporting event or even a rock concert. The Rev Dr Billy Graham, who has addressed more people than any other individual in the world, has been in the nation's White House for each of the ten presidents since Truman and has been considered an unofficial advisor to eight of those. Truly a remarkable status. And still no one knows his political affiliation or his position on any issue. He is always seen as speaking in the interest of those he serves; never in self interest for his profession.

Perhaps not an exact analogy, but would it be possible for physicians to be held in such high regard that when things related to health care come up, the president and congress, as well as the governor & legislature, would seek out our opinion because they knew that it would always be based on our patients' interest rather than our own?

We have lobbying offices in all capitals and access to virtually all members of congress. Still when the largest health plan ever proposed was being developed during the current administration, the doors were closed to us. Why are our opinions disregarded so often? Are we not generally perceived as being self serving?

It is difficult to find physicians who are happy with their current practice arrangements. Considering this sad state of our affairs in the practice of medicine, could we possibly be any worse off if we reduced our political spending? Or for that matter, does anyone really think we would be better off if we increased our political spending?

There are no easy answers. But somehow, our voice must always be perceived as being in the interest of those we serve rather than our own interest. The CMA & AMA are our best and only avenues for change. They deserve our support. There is no alternative. Con-structive criticism is the first step to improvement.

In the two examples we started with, instead of an official position stating that the AMA thinks it's OK to kill anencephalic babies, then reaffirming it (JAMA Dec 13, 1995) and two weeks later reversing it, wouldn't it be more appropriate to simply have underscored the issues? Maybe we should point out the difficulties involved in defining death medically, defining death legally, and defining death morally, and allow the matter to evolve with our continuing participation in an active debate. As the experts, we can point out how this rare medical abnormality further complicates difficult issues.

Or in regard to the efforts of the AMA president to lessen the onerous burdens on doctors' labs which allow us, according to the press, to make more money, we should highlight the misperception. We should state that if congress is concerned about the cost of health care, physicians labs are about half as costly as others. Relieving the onerous burdens which are causing physicians to close their labs would be in the patients best interest. Also in the fiscal health of our country.

By openly presenting the issues to the lay public in terms that they can understand, we will regain the confidence of the public and also our elected officials. The lay public will be much more effective in calling, mailing, faxing and Emailing our representatives until they respond in our patients interest. Or our patients will vote them to death.