Saturday, March 31, 2012

Medical Professionalism Charter 2002

Lancet and the Archives of Internal Medicine in 2002 published the Medical Professionalism Charter 2002 renewing committment to patient care as primary, committment to patient autonomy and a committment to social justice.  Harold Sox, Annals of Internal Medicine, Feb 5, 2002.
I studied community medicine and public health and served in the areas of greatest need. I wrote a paper on Social Responsibility for the Canadian Journal of Psychiatry. I served in the north where doctors simply would not go and in asylums where psychiatrists couldn't be recruited. I worked pro bono for years in many areas and with the dangerously insane and the infected and questionable.  I got on well with doctors who had done missionary service. My colleagues who were most successful and most lauded in awards and promotion were highly particular about concern for the richest of patients.  Indeed, the doctor to the king, has always gone a lot further than the doctor to the poor. I've been an outsider stigmatized with the same stigma that my patients experienced.
Now I see that 'social justice' is part of the 'new world of order' in the 'profession'.  Irks me, considering how much heat I have taken personally for championing lost causes and fighting for the disenfranchised and going where doctors wouldn't go.  I was told by one of the head doctors in the Canadian Medical Protective Association that I was the most persecuted doctor they knew while at the same time I was told by a former head of the Canadian Medical Association that I was possibly the only  psychiatrist with integrity in the province.
I muddle along.  I love medicine and the practice of medicine.  I daily though seem to be fighting government for services for my patients, patients who as ignorantly as I assume those services are available to them as part of the social contract and the taxes we pay.  There have been no elective hospital beds and no nurses and demands for everything political but health care.  I feel like a cop who goes from fighting crime to guarding parking meters.
The charter makes a committment to patients, a committment to honesty with patients, committment to patient confidentiality, committment to appropriate relationships, with patients, committment to improving quality of care, committment to improving access to care, committment to just distribution of finite resources, committment to scientific knowledge, committment to maintaining trust by managing conflict of interest, committment to professional responsibilities.
It has been my experience the authorities pay lip service to the 'committment to honesty with patients."  It's a crock. My own experience and the experiences of my patients testify to the hierarchal dishonesty in the system. Twice I have had doctors lie in their care for me to cover up their errors and save their asses. It's a routine failing in the system.  I have witnessed it routinely.  It's as if there were two ledgers in the health care system, one for the patient to read, and one for the authorities. The same system applies in the baurocracy with secrecy and close doors and clandestine discussions.  Until there is a 'culture of honesty' there will only be the appearances in this regard. The reason I am following the Julian Assange case and Wikileaks is that it speaks to our very own governments real position on honesty to those who are served.  There is too much power in secret societies to expect this to go away with flowery words.
Committment to just distribution of finite resources - I can be committed to anything but in the end the rich and powerful get the kidneys or whatever. No one I know is standing in their way and all of the beaurocratic authorities have been there to assist in this.  Committment to scientific knowledge seems to be mostly whatever scientific knowledge is fashionable.
I am hopeful regarding conflict of interest.  I was forever getting into trouble objecting to the conflicts of interests in patient care. People were doing all manner of dirties locally and I was getting into all manner of trouble bringing it to the attention of the authorities. It was al most like 'no publicity is bad publicity'. Caught red handed the perpetrators of heinous wrongs went right on doing them at increased profit.
Now I don't see this so much.  Partly because I've taken to looking the other way like most of my colleagues always did.  Partly because pharmacists are calling themselves 'professionals' and people are expecting them to act in a less cavalierly tyrranical manner than they have to date so the heats off the doctors and moved to the pharmacists and perhaps others in the system rich on conflict of interest.
Committment to professional responsibilities is a vague thing. The more I 've been committed to my profession the more I've been criticized.  As a specialist and subspecialist I've devoted another 6 or more years of loss of income and study to being trained at best for my patients while my colleagues who didn't do further training remained with position authority and gained more money and power. Today it's common to see the highest ranking professional being ordered about by the lowest common denominator in the health care system. The patient and the doctor are least welcome too often.
I think the charter is a good thing. I wonder about the language. It seems a lot of work and yet it doesn't appear to add much to the code of ethics for physicians . I am not sure I agree with words like 'justice' being used in medicine given such short thrift the word got in legal circles. Blind judges are one thing but blind surgeons are another.
Since 2002 things don't seem to have got much better in the patient care area despite this fine manifesto and I fear mostly there are fewer and fewer hands to do the work while more and more people seem to be getting paid vast sums to talk about the problems of the patients.
That said the charter overall seems fine unless it is used as too many such papers have been used, to beat doctors and deny patients. The devil is in the details.

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