Company Doctors: Professionalism and Political Correctness

Historically, physicians among professionals have had the highest rating for trustworthiness and truthfulness.By contrast lawyers have been at the bottom of the heap.  Some actually say it’s sad that 90% of lawyers give the other 10% a bad name.  My old lawyer friend had insisted that this was  a product of the rise in social legislation that followed Prime Minister Pierre Trudeau’s reign.  My friend, an  old man, had  practiced law in Scotland before coming to Canada.

“I was proud to be a lawyer. It was a very honoured profession in my youth. Today I sometimes feel it’s just because of the money lawyers are perceived so negatively. I did well enough but if money was the sole criteria I’d not be thought as good a lawyer as some of my colleagues who sought celebrity and seemed only interested in the fame and fortune.  When I became a professional I saw it as a duty and service and frankly most of my colleagues saw it as that too.  We were there to serve people. Our independence and autonomy as professionals allowed us to protect our clients from governments and corporations alike.”

It wasn’t long after I heard him say that, that  a lawyer at my church told me “I think you can still can be a lawyer and a Christian in Canada but I no longer think you can be a Christian and a Corporate lawyer in Montreal.”

I can say the same is increasingly  true for doctors.  The lowest slur a doctor could make against another was to call him a “company doctor”. 

The ‘company doctor’ reached it’s a nadir during the years of the asbestos mining.  Miners were coughing up blood and dying all the while the doctors hired by the company and were paid exorbitantly essentially to lie and insist the problem wasn’t the  asbestos at all.  The miner instead, in classic ‘blame the victim’ was told he had ‘weak lungs’. It became the  great scandal of the era exposing corrupt courts, government, corporations and the doctors involved..  Science eventually prevailed as today we know and diagnose “asbestos lungs’. 

It should be understood that a doctor may give his opinion in court ,which remains a 19th century rationalist construct and sees the world in black and white as opposed to the multi factorial quantum universe considerations of 21st century rainbow science.  The ridiculousnesss of such ‘opinions’ was highlighted best by the farce of the OJ Trial with all its dream team and ignorance of DNA. 75% of the fruitfly DNA is the same as Human DNA. 

In British Columbia “Moynihan’s Law’  was enacted essentially to reign in the competing claims of ‘expert witnesses”.  Moynihans’s Law insisted that expert opinions be predominantly objective and serve the judge not the solely the lawyers paying them.  Some of the insurance company expert witnesses were paid so exorbitantly as to make the ‘company doctors’ of the asbestos mine era look like altar boys.   Tragically I was obliged to teach a judge the history of this in recent years, as he appeared to have missed out on the insanity of the courts that required a specific new “Moynihans’s law” to reign in the ‘expert testimony ‘ of competing factions.  Perjury laws have always existed but do appear to be rarely used as increasingly the courts move away from the ‘truth’ standard of old.  “The truth, the whole truth and nothing but the truth” is no longer associated with the modern court but rather remembered as a line from the Perry Mason era. 

The judge appeared unaware of Dr. Jay Lifton’s seminal book, the “Nazi Doctors” which addressed the whole issue of the ‘company’ or ‘government doctor’ in exquisite horrifying detail.  

It should not reflect badly on this judge because we’re collectively seeing this phenomena today  in the ‘fake news’ . The media was once constrained by the idea of ‘fact’ but today has  lost all track of the very notion of  ‘objective’ and now sells ‘facts’ as ‘opinions’ to the highest bidder.  Judges, themselves, have historically been considered’ corrupt’ as their opinions have been on occasion bought as readily as world soccer players.  The remaining issue today ,as Canadian culture devolves into multiculturalism,  increasingly,  is not whether someone will sell out their integrity but at how low a price.

Around  the world in other jurisdictions and cultures the issue is not whether to bribe the official ther how little one can give without insulting   government representative. The whole idea of the ‘tip’ which once was only an issue in hotels and restaurants is the very basis of business and law in`many countries.  

The next worst ‘slur’a doctor could have against him was that he was a ‘pharmaceutical company doctor’. Some pharmaceutical companies hired doctors to promote their medications and rewarded those who ‘sold’ medications by down playing or denying risks while celebrating success.  I was hired only a couple of times by one drug company to give talks to family physicians about new produce.  I was subsequently   told by  that company that  I was ‘too objective’ and hadn’t ‘sold’ enough of  the product. . I took that a compliment but it caused me to look askance at some of my colleagues who took pride in being consider ‘trendsetters’ by some in the pharmaceutical industry. They considered it a compliment to be called ‘drug pushers for the multinationals’ and paraded their academic and financials rewards with gusto.   “Unhinged: the Trouble with Psychiatry” by Dr. Daniel Carlat discusses this problem in depth. 

It became so egregious an issue in medicine  that physicians in academic settings and journals are collectively now required to give notice of their ‘conflicts of intererst’.   At the beginning of a lecture a doctor is required to put up a slide indicating which drug companies or businesses had paid him for this lecture or his research in this area.  

Unfortunately the licensing bodies for professions, in general, like the Colleges of Physicians and Surgeons, have not as yet had such a renaissance. The conflicts of interest that influence hiring, appointments,committe membership of non professionals,  their  political and fashionable decisions remain darkly opaque.

  

This practice has been in place for decades and naturally doctors wish that politicians and bureaurats would be required to do the same housekeeping regarding ‘conflicts of interest” and ‘lobby groups.” The partisanship of bureaucrats is a huge problem since they are required to be 'objective' but increasingly in Canada it has been exposed that government bureaucrats are Liberal biased.  To avoid this in many countries and eras the whole government apparatus was overturned and replaced by the followers of the winning party.

Given the scandals  over the foreign influence on Hillary Clinton and Justin Trudeau by Islamic countries and the alleged influence on Trump by Russia , politics seems mired like the media and courts outside the promises of the 21st century.  Escobar, the great drug lord used to brag that he had bought both the Republicans and the Democrats, hedging his bets, not that that did him much good in the long run. 

Doctors addressed this issue of autonomy first in the Hippocratic Oath of Ancient Greece.  I’ve taken the revitalized Hippocratic Oath of today since the ethical and moral foundations of professionalism have been increasingly eroded by government intrusion. The ‘do no harm’ clause is all but obsolete now  the ‘abortion industry” and recently  ‘euthanasia industry’ have completely won over the prevailing  government and their bureaucrats so reminiscent of the 'banal' of Arendt's writings.   Further, the various ‘codes’ of doctors in the western world were influenced by the “sanctity of life’ premise  inherent in Christian religion which inherited and refined the Judeo Graeco Roman traditions from which Western Civilization arose.  Other cultures have not had this notion of ‘sanctity of life’.

Further the ideas of where on the continuum the doctor sits regarding the collective and the individual are wholly different than what most Canadians assume.  Also the 'accountability' of the doctor in different countries is wholly different from the local ever changing responsibility of the doctor and indeed the health care system. This was never better reviewed than the greatest scandal of hospital administration of our time, the finding of the man dead for 36 hours in the Canadian teaching hospital and the abdication of accountability of administration.

There is also distinctly different ideas of cause and effect and accountability in eastern and western 'culture' which affect the very practice of medicine by doctors depending on training and background.

It was no surprise that Dr. Kellie Leitch, a brilliant physician and accomplished paediatric surgeon, should spearhead the importance of 'Canadian values' in this time when the dope smoking pretty haired selfie snapping Canadian Prime Minister Justin Trudeau was insisting there was no 'Canadian culture' and hence no 'Canadian values'.  Ironically he also said that Quebec French  speaking Prime Ministers were superior to English speaking Prime Ministers when his basic premise was that there was no such thing as a Canadian ‘culture’. While denying Canada 'culture' and denying Canadian 'values'  he insisted on the superiority of the French speaking. 

The word ‘culture’ derived from the Latin word ‘cultus’, ‘to care’ and from the French word to ‘cultivate’ or to ‘fill the ground’.  Well no one in their right mind would doubt that Dr. Leitch cares or is a highly cultivated individual who has done a lion’s share of work, there continues to be complaints about PM Justin Trudeau, simply not caring about Canada, and not by his personal history having much to do with cultivation and work.  Unfortunately Dr. Leitch’s insightfulness flew over the stoned heads of easily offended young followers of the Prime Minister. 

The ‘private’ physician retained their autonomy and worked for the patient just as the lawyer and accountant and engineer primarily served their client.  Historically the true ‘statesman’ served the country as a whole not the entrenched interests of corporations like Bombadier or the  urbans tastes of Montreal female voters.  

The ‘business’ of profession however always was tied to the idea of ‘he who pays the piper calls the tune’.  As the “private” physician was working directly for the patient even though an insurance company might well be paying the bill, the doctor’s greatest concern was the ‘patient’s health’.  This was before the Hydra of  Cultural Marxism's weaponized political correctness redefined 'health' like the 'renaming' of 'gender" as something other than the ‘morbidity and mortality’ of science.   

Today the ‘insurance doctor’ is the next greatest ‘slur’ that can be made against a doctor.  It’s a bit wrong as there clearly are good and bad insurance companies. But clearly if the patient becomes sick and unable to work and provide insurance payments it’s in the interest of the insurance company to ‘de list’ that member as they are no longer a viable ‘client’.  Further, the worst insurance companies use and abuse the courts to offer the least inclusive definition of health and spend fortunes on lawyers fighting claims. 

Canada is a single party insurance scheme so that the ‘government doctor’ and the ‘insurance doctor’ ‘slurs’ can overlap.  Historically in public and private endeavours there was this area where the public need for finance existed because of the size and ‘risk’ of the project and in areas where there was no likelihood of profit but that as a society we collectively saw a need to care for others in a way private sources could not afford to.  

Our present government appears to be giving billions to foreign countries while not caring for it’s own sick and old.  The sick and old and those who suffer catastrophic  injuries were the principle reason for development of the Canadian Health Care system.  Tommy Douglas and those who were  principally Christian doctors of the  Saskatchewan model would obviously roll over in their graves  if they were to see the actions of the ‘company doctors’ and ‘government doctors’ of today.  Government spending today,  is to those early men and women of Canada,  a total corruption of the ideals of Canadian traditions.  Not surprisingly, Liberals get around this by indeed,   denying Canadian culture or tradition.

The highest paid doctors today are government doctors  and cosmetic surgeons while the front line workers in all fields are policed to no end and treated as the enemy by their superiors because they have been given the unenviable task of ‘rationing health care’ while the government doctors and political doctors make endless promises that are simply impossible to meet.

Professionals say that there is no ‘autonomy’ or ‘profession’ any more because the structure of our present centralized communist leaning government which is totalitarian authoritarian and diametrically opposed to the freedom of the individual and wholly supportive of the ‘collective’.   Indeed many professionals have considered that the ‘unions’ which developed in a much more hostile relationship to government may be the answer to the failing health care system.  Some doctors have approached the Teamsters feeling the whole idea of ‘profession’ is defunct in face of government corruption and the cancerous growth of the government burocracy to the detriment of professions and their clients.  

Canada has a history of having had a purely ‘government socialist based’ health care system which was associated with the worst morbidity and mortality statistics in the Canada. This was the Indian Affairs government health care system which is now being used as a "model" for all of Canada despite is at times horrendous failures.  

Given that immigrant doctors increasingly come from countries which do not share  Canadian ‘values’ of ‘sanctity of life’ , the importance of the individual, freedom, and libertarianism and other such ‘pesky’ ideas it is increasingly no surprise that the government calls’ physicians’ not by their ‘professional designation’ but increasingly as ‘health care workers’ as a collective job title. Ethically there fore in the government eyes they have no difference from the cleaning staff in the hospitals.  

It concerns me as the corruption of government and media and the refusal of the courts to move forward that doctors medical professionalism is now defined solely by ‘company doctors’ and dominated by ‘conflicts of interest’ that soon it will be said of doctors that 90% give the 10% a bad name.  It is no surprise that 75 % of Canadian doctors would not recommend medicine at present in Canada. 

As a dinosaur doctor I am increasingly concerned about health care not as much as a provider but because I might well need services and can see from the desperate experiences of my patients that they are utterly frustrated, dissatisfied, and wholly crippled by the government callousness, Naturally their opinions never appear in the government propaganda media or are always attributed to the doctors and nurses rather than the top heavy administration.  They express repeatedly concerns about  inefficiency and corruption the feeling that their basic needs and values are not being met.

A company doctor explained to me that I ‘cared too much’ and must ‘lower my standards’ as well as ‘learn to lie’ as he did for he enjoyed greatly his well rewarded government company doctor lifestyle.  I personally have to consider every day whether I want to continue as a ‘company doctor’ or if I should, like the other dinosaurs of my era retire early and accept that Christians, godly people in general,  moral people and all the doctors of old, especially my most esteemed mentors, and Tommy Douglas, a politically incorrect Baptist minister, are all  no longer welcome in Canada.  Insurance company models also routinely reward the physicians who do the least for the patient and save the government the most money.

This was a 'joke' of my surgical training where heart surgeons and lung surgeons would compete among themselves as to who could use the least 'thread' as the administration had a fashion of the month campaign to get the surgeons to save money in the operations.  At the time I thought it was something out of MASH where no show better defined the oxymoron on 'military intelligence". Yet the surgeons explained that the administrators were more concerned with their budgets than the lives of the patients. Indeed I caused myself no end of difficulty complaining that a small town administrator had robbed the hospital budget for a baby incubator so that he could have a new desk and chair with better wood panelling.  

I do envy the migrants who routinely return to their ‘homes’ whereas I personally feel my own home and profession have been destroyed.  This feeling has grown strongest since  I was told that  Dr. William Osler is no longer considered a ‘professional’. Clearly Dr. Osler is no longer welcome in Canada and  should never  apply to work here.

Jesus, the greatest healer of all time, would not be welcomed  either.  Jesus  was vulgar, kept the wrong company,  swore and behaved badly, the epitome of a politically incorrect individual.  Politically correctness and professionalism were once diametrically opposed.  Today a doctor kills or heals as the prevailing mood dictates. It’s just fashion.  Medicine is theatre.  The Kardashian’s are the new models of medicine.    

Social Justice and Physicians

I have been reading again the Charter on Medical Professionalism put forth in the Annals of Internal Medicine, Feb 5, 2002 by Harold C. Cox, a project of ABIM Foundation, ACP-ASIM and European Federation of Internal Medicine.  In it there are three principles, Principle of Primacy of Patient Welfare and Principle of Patient Autonomy and finally Principle of Social Justice. It's the last one that catches in the craw.

It says the medical profession must promote justice in the health care system, including fair distribution of health care resources.  Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion or "any other social category".

It "sounds" sweet and nice and sugar and spice but really is it 'reasonable' or 'emotionally sound'.  Collectively it's a good thing for the profession to promote those things that make any 'brand' look good.  However this all round 'anti discrimination' clause seems horribly reactionary and communist rather than socialist even but especially anti capitalist.

And really "any other social category".  I immediately think should a serial murder in prison have same access to cataract surgery as the neonatal brain surgeon.  What is most concerning is this 'any other social category'.  What concerns me here is the 'entitlement' in society today where people who do not contribute to 'insurance' plans expect equal benefits from those insurance plans.

Further we specifically as physicians have 'rationed' health care resources on the basis of 'compliance' with treatment. I was early involved in the decision to give 'pig skin heart halves' to chronic alcoholics over mechanical heart valves because of the issue of 'blood thinners'. The chronic alcoholics would be at risk of not doing the appropriate after care and with the lesser beneficial 'natural' valve there was less after care.  Given this clause I would think this reasonable medical decision making would be considered discriminatory towards an individual who is choosing excessive alcohol as a 'cultural imperative'.

I have spent alot of my career doing 'missionary' type work, choosing to work always in the areas of 'greatest needs' and not choosing the areas of greatest comfort, prestige or monetary reward in the profession. I could well have become a plastic surgeon but instead became a country northern physician and later a psychiatrist and addiction medicine specialist. I certainly would like more resources compared to my rich and richer brethren but somehow I don't want them if my plastic surgeon buddy with his multi millions is penalized for his attention to breasts and noses.  I think this 'clause' is destructive of what was always thought of as key component of medical professionalism, that is 'physician autonomy'.

I read this charter and it reads like a government employment brochure. It's a great salaried position yet it overlooks the word 'freedom'.  Professions have attracted the very best because of the potential for 'autonomy' and 'freedom'.

This charter by it's failure to address such central issues while focussing on matters such as "committment to just distribution of finite resources' and committment to professional responsibilities, seems highly weighted to governmental imperatives.

I personally was attracted to the profession of medicine because I was enterring a covenanted relationship with a patient in which I was to serve as a 'healer'. Clearly I would put the patient's interests first but how it was decided who would be my patient, the patient selection process itself, was never something I thought it was the responsibility of the 'profession'. In this way I'm arguing against myself in fact but that itself is 'professional'.

My first position was to go to a country hospital whereas the city positions carried more glamor, luxury, resources, pay and priviledge. I was a leading doctor and have always have tremendous choice something that perhaps those at the 'bottom of the class' didn't or didn't perceive.  Many of my colleagues today choose the 'easy street' of 'administrative medicine' which carries power, priviledge, and 9-5 jobs and no patient contact with considerable capacity to be extraordinarily parental.  Others choose 'forensic' medicine where there's a 'capitive' population.  There is limitted considerations of 'social justice' in either of these spheres.

I was the only provincial doctor willing to work in Northern Manitoba on the Island Lake reserves the years I was there. The Northern Medical Unit had to bring in doctors from England to take positions which for 2 years could not be filled because of the low pay, high risk and general unattractiveness of the position. I got TB. I was in a plane crash. I was attacked. I was injured. I went through the ice in a snow mobile on a mercy run. I was without resources on many occasions. I had little back up. The greatest priviledge of the position was working with Dr. Jack Hildes.

After country medicine and northern medicine I did a community medicine, public health and psychiatry residency. There was no support in the psychiatry residency for 'social medicine' at the time.  I wrote a paper on 'social responsibility' and it was belittled.  The psychoanalytic model at the time favoured 'labour intensive' service for a few whereas despite my psychoanalytic training I went to work in the provincial asylum where no Canadian Psychiatrist was willing to work.  The conditions for physicians were horrendous.  Patients had it almost as bad. The administration was living the life of bliss.

As a psychiatrist I worked in the country and the north again and then moved to work in addiction psychiatry.  My life has been threatened repeatedly. I have lost hundreds of thousands of dollars because my patients can't pay and the system penalizes doctors working with those who lack resources.  I have found in general the stigma against psychiatric patients and those who care for them suffocating.  I am now working in the Vancouver downtown east side with homeless drug addicts and street prostitutes part of my week. The hospitals and their services literally abuse my patients and myself because of the frustration within the 'system'.

I was a member of the International Society of Physicians against Nuclear War which got a Nobel Prize one day. I was never in favour of 'unilateral disarmament' during the cold war.  I think it's a good thing to consider 'social justice' but given the present administrations in Canada, those managing health resources and their desire to increase their positions and their pay without having a similiar committment to 'patient's first' I'm concerned that we as physicians giving up 'autonomy' will play into the nefarious self interest of these groups who have to date not demonstrated their ability to have high ethical standards.

I see that my colleagues are willing to do 'service'. It's extremely common for missionary doctors to go to work in equally difficult place. The Evangelical Medical Association is forever having doctors volunteer to work in difficult situations yet most would not have worked in the situations that I have because of the government interference in health care, the over riding tendency of administration to use whips rather than rewards and all manner of concerns with health care in secular societies.

The greatest risk to patients is the 'company' doctor. The 'company' doctor or 'government doctor' was a doctor who to protect his own position of priviledge did as he was 'told' and 'told' the patients what the 'company' or 'government' propaganda or corporate stategy of the day was.  He was a 'cog in the wheel' and his 'cowardice' in the medical community is legenday.  He was described in detail by Dr. Jay Lifton in "Nazi Doctors".  I personally don't want to be a 'nazi' doctor. I want my freedom and the patient's freedom enshrined.  I want choice and I want the patient to have choice.  Together we choose and together we stand.  That's the nature of covenant. That's historically the nature of professionalism.  This instead is something else and so watered down as to serve neither patients or doctor but likely to serve special interest groups and destroy the very trust that patients have historically had knowing their physicians are 'autonomous'.  This emphasis on freedom and autonomy is not dealt with in the 'committment to conflict of interest'.  I fear that the writers of this charter don't grasp or agree with what I and professionals before me meant by 'freedom" and 'autonomy".  Alternatively they may have deliberately excluded this in preference for this 'brand' they are definitely promoting as a universal when truly I believe it falls far short of encompassing the purest conception of medical professionalism that has allowed it to spread world wide and served so many of us even as we are ostracized by those who have so many resources.

This charter of medical professionalism fails extremely because it in no way protects the autonomy of the physician. It doesn't address the need for a physician to ethically and morally refuse to participate in situations where it is obvious that 'systemic' abuse is taking place.  It indeed appears to serve not the 'patient' but the very agencies that have so often ensured resources do not get to the patient or the physician providing direct care.

Professionalism requires 'autonomy' and 'freedom' for 'physician' and 'patient'.