The California Medical Association held the first of what is hoped to be a yearly Leadership Conference at the La Quinta resort near Palm Springs. Approximately 400 of Hippocrates’s modern-day kin and invited healthcare “leaders” were present.
The keynote speaker was Emily Friedman, writer, lecturer, health policy analyst, and ethicist based in Chicago where she is the health policy and ethics analyst for JAMA. She enjoys coming to California because she loves sports, and Healthcare in California is more like a sport. When a student doctor on the west coast asked where to go to practice, he was told, “Go east, young man, go east.”
She pointed out that in film in times past doctors were portrayed in a negative fashion in only one case out of a hundred. The oldest trust relationship-that between physician and patient-is on the line. Now, the most trusted person in healthcare is the nurse. When she asked a nursing group why this was, a member of the audience replied, “It’s because we always worked for a salary.” She pointed out the difficulty of having doctors work on salary is that less work gets done. As an administrator pointed out to her, “When the doctors work on a fee for service basis, you can’t get them to attend a meeting. When they work on a salary, you can’t get them out of a meeting.”
Physicians have always been very thinly regulated. But when you live outside of the law, you have to be honest. You shouldn’t be making 10 times as much as the person paying you. Congress can’t raise their salaries fast enough during the dark side of the moon to keep up. When someone asked her, shouldn’t society decide on whether they want universal coverage, she disagreed. Society does not decide. Where would they hold the meeting? When Lincoln issued the Emancipation Proclamation, it was not a position held by the majority of the country. It takes a person of vision, honor and charisma to bring about needed change. The challenge is for physicians to represent their patients.
The ethical theme the first day was physician assisted suicide (PAS). Dr H Rex Greene, an oncologist, pointed out the proponents of the PAS movement have an inverse relationship in their activity to their experience with dying patients. We have to handle the problem of pain in the dying. His hospital grades pain as the fifth vital sign.
Stanford Ethicists Ernle W D Young PhD pointed out that a public policy for PAS is problematic. In The Netherlands, it is no longer the release from terminal pain that is the criteria. It is now used for the elimination of the senile and disabled.
Peter Boland, PhD, a prominent writer in the health care field (His book, Redesigning Healthcare Delivery, is over 900 pages and costs $159) pointed out that 35-40% of what we do in health care has very little emotional or clinical benefit to the patient. The patients have voted by taking 40% of health care out of the market into alternative medicine.