San Diego Physician editor, Paul K Raffer, MD, gives the demographics for San Diego. Of the 5700 practicing physicians in the county, 2000 members of the medical society. The majority of nonmembers are staff or group practitioners. Of Kaiser’s 650 doctors, 33 are members; Scripps Clinic has 56 of its 400 staff as members; and UCSD has a grand total of 29 of its 1200 doctors as members.
John Greisman, MD, president of the San Diego County Medical Society, found that San Diego doctors had an opinion that was at variance with CMA, AMA, Democrats, and Republicans. He points out that county societies are component societies, not chapters and hence are not required to accept, as policy, statements by the leadership of the CMA or the AMA, which has an “inside the beltway” mentality, driven by staff and abetted by legal counsel. He finds it difficult to determine who really speaks for the members. If members opinions had been sought, perhaps the Cal Advantage debacle could have been mitigated.
Kevin P Glynn, MD, a pulmonologist who completed his term as editor of San Diego Physician, puts our problems in perspective. “We physicians paradoxically cling to antiquated methods of record keeping and rely on ‘clinical experience’ to guide diagnosis and treatment yet espouse new clinical techniques with minimal evidence of effectiveness. Our system of recording and distributing medical information is retarding medical quality. It is archaic and inadequate for the intricacy of contemporary care. No other important segment of contemporary society uses hand written notes (mostly illegible) to communicate information among workers. It is no wonder health policy planners resort to using administrative and financial data to seek information on clinical outcomes . . . [which are] inaccurate. . . . The [AMA-HCFA E & M] fiasco illustrates this. Imagine trying to decide what salary to pay a baseball player by counting his swings during batting practice. . . We need most an efficient electronic medical record to make things come together, and that’s the weak link in the chain. . . The person who creates a coherent system of tracking patients’ data, transmitting information smoothly from office to office, from laboratory to clinic, and from hospital to nursing facility, will make billions of dollars and deserve it. . . Doctors are essential at every step in the process. . . High quality care will follow and health plans and journalists will have to seek other answers for remaining weaknesses in our health care system.”
Richard Marsh, PhD, a forensic Psychologist, reported at the annual meeting of the American Medical Writers Association, that after losing his first legal case 20 years ago over a fender-bender, he became a student of the legal process. He found the process frustrating and screwy. After 20 years of testifying in numerous child custody battles, assessing criminal defendants, and psychological injury, Dr Marsh reached a curious conclusion. “Evidence is viewed with respect to certain criteria, and most would have you believe there are only three: written law, case law, and procedural law.” The salient factors influencing the process, however, is its overarching hypocrisy: “We say that all the evidence will be admitted, that all the witnesses will be heard, that each side will have a fair shake, but we don’t mean it.” The legally naive can find the system’s attitude toward lying especially galling. “Hypocrisy is rampant in the language of perjury. We are taught that perjury is lying under oath. In fact, perjury is defined as a false statement which has probative and compelling impact on the outcome. So if you lie and either they don’t believe you or it’s not very important in determining the outcome, it’s not perjury. . . In certain instances you are expected to lie by omission.” He illustrates this by the disclosure of a jailed suspect who admits to shooting a cop is enough in itself to declare him incompetent.
James K. Gude, MD, Santa Rosa pulmonologist, editorial board member and classic book reviewer for Sonoma County Physician, recently reviewed A. J. Cronin’s 1937 novel, The Citadel, in an editorial. Just as Dr Andrew Manson, the protagonist, moves to London to make more money, various corrupting forces enter his life and he becomes avaricious. As his wealth increases, so does his obsession with power. Manson rises to the top of committees and staff organizations so as to control others. He endorses commercial products for a lucrative return. Dr Gude feels the story is timeless and that we continue to face the same corrupting forces of greed, power, and ignorance. The problems of the good physician lie in sustaining this “good,” given the weaknesses of human nature and our medical system.