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Thursday, February 21, 2013

The language of academic medicine has become the language of the collective

One of the many changes that have occurred in medicine over the last 40 years ( my professional lifetime)  has been the framing of certain aspects of  medical care into the language of the collective. I have written before abut the bogus nature of the concept of the "Medical commons" (see here for critique of the medical commons bogus analogy ) but that is only a small example of the dominant themes found in medical literature and not just just in the policy wonk journals and editorials such as those found in the NEJM but also in throw away comments found in the boiler plate like introductions to what otherwise are serious medical research papers. How many medical journal articles have you seen that begin with commenting that  disease x, y or z is an important pubic health problem? Defining everything as a public health problem cries out for public health solutions. Are there any health issues that are simply a matter between the patient and his physician?

The concept of social justice as an ethical imperative of physicians which has though the efforts of a small group of prolific academic writers,certain foundations with deep pockets  and medical insurance industry shills has  become the de facto default position of medical academia and the self proclaimed thought leadesr  and will become standard catechism for the present and future generations of medical students.Aspects of this con job (better word?) has aspects of the  features of the classic Baptist and Bootlegger phenomenon. As some  members of the medical academia promote this view and move out of and into the medical insurance upper level management and various government positions of power it become difficult to identify who are really the baptists and who is conning whom.  Yet,I continue to believe that many of those who advocate social justice and believe that physicians should be the stewards of society's medical resources do so with sincerity and in the belief that these are meaningful terms and worthy goals while at least a few of us believe that allegiance to bogus concepts usually does not work out very well.

 Ask not what you can do for your patient but what you can do for the greater good of the group,ACO or payment panel which you and your patients by random chance have become part of.After all if you do what is cost effective the group will benefit and through some type of metaphysical fairy dust so will your patient even if she or he is deprived on a beneficial test of procedure or medication because he/she is part of the group.Rather than comments like the preceding  being shouted down with a John McEnroe like " you've gotta be kidding" we see that that type  commentary in the NEJM offered by a well known medical economist.See here for the comments of Victor Fuchs and my criticism.

Since few would doubt that academia in general is populated by a preponderance of liberals, progressives and egalitarians ( See here for some survey data)  why be surprised that medical academia is no exception? The question is why is it that only fairly recently has the rhetoric of medical publications so strongly reflected that mind set appearing not just in editorials and commentaries and in health policy publications  but regularly in the boilerplate introductions to otherwise ordinary presentations of a medical studies.


Phil_in_VA said...

What do think of Steven Brill's blockbuster piece in Time Magazine? I'm sure you'll have a lot to say. I haven't read it yet (it wasn't at my neighborhood 7-11 yet). I'm looking forward to your estimation of it. He's on Charlie Rose now, "there never can be a free market [in health care]" quote from S. Brill.

james gaulte said...

Thanks for the reference.Brill's article covers a lot of ground.He seems to shine some much needed light on the so called non-profit hospitals, a topic I will have to comment on.