Wednesday, February 23, 2011

Fake notes by real docs: it's about our professional culture, not individual docs

I blogged yesterday that the fake notes real docs scandal in Wisconsin was more about a cultural shift in the profession than about the docs handing out notes. A recent Pajamas Media article examines the Wisconsin situation in light of the cultural shift towards a “new professionalism.”

Although I say “new” it's an agenda that's been playing out for several years. It's one that has been advanced by some of our professional organizations. The article cites two documents, one issued by the ACP and the other by the AMA. The ACP paper, titled Medical Professionalism in the New Millennium: A Physician Charter strongly implies but comes just short of saying explicitly that this new professionalism demands doctors advocate in their communities for a progressive agenda. The AMA paper is of the same ilk but deals more with medical education. That paper advocates a de-emphasis on the sciences in favor of community organization, systems thinking and social justice. At first glance the recommendations seem soft because they are vague. But it's the vagueness that makes the slope toward UW Family Medicine style ethics more slippery. (For a nice fisking of the AMA paper read this).

I'd be remiss if I didn't mention the AMSA. Though not directly involved in what's happening in Wisconsin this is just their kind of project, which makes their absence seem conspicuous. AMSA, the largest and best organized medical student group, has been profoundly influential in student education and professional development. AMSA's extensive web site is almost complertely devoted to activism and advocacy. (In fact, the only clinical content to be found is promotional and non-critical material about complementary and alternative medicine).

The influence of this culture is well illustrated by this post and embedded video from Ann Althouse in which one of the street docs said he thought this was an “OK thing to do” in the cause of social activism.

So if it's about a pervasive culture more than individuals what about the doctors handing out the notes? Should they get a slap on the wrist or go to the wood shed? What should the university and the medical society do? I'm glad I'm not in the position of deciding, but I would be more lenient than some, especially toward the poor residents. After all they were just doing what trainees are expected to do, emulating the faculty mentors (and even their program director!) who were out there doing the same thing. Maybe a special accountability rests with the department chair for allowing this mindset to flourish.

I'm not interested in careers being damaged.  I do think, though, that this almost ranks with quackademic medicine in the category of things worthy to be held up for ridicule.  Maybe the blogosphere will change medical culture, maybe not.  If nothing else the Wisconsin event has great entertainment value.


Virginia Doc said...

For chrissake, what's with all the "get off my lawn" crap lately? I mean, I agree with you about Wisconsin, but you're like my dog with a dead rat. Yes, yes, we see that you got yourself a rat. Good job. Now please stop dragging it all over the place.

Seriously, if I wanted cranky old man, I'd watch Gran Torino again. At least he was able to move on.

R. W. Donnell said...

Hmmm, Doc,

You seem to be suffering from a case of perseveration about old men and lawns today.

OK, you'd like me to tone down "the rhetoric." I get that. Thanks.