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Is the new professionalism and ACP's new ethics really just about following guidelines?

The Charter ( Medical Professionalism in the New Millennium.A Physician's Charter) did not deal with just the important relationship of ...

Thursday, September 03, 2015

George Soros's Open Society Institute and American Board of Internal Medicine Foundation programs,strange bedfellows or birds of a feather?

Medical Professionalism for the new Millennium; A Physician's Charter was published in 2002 both  in the Annals of Internal Medicine and in the Lancet reflecting an international authorship. In 2003, George Soros's Open Society Institute founded a think tank, advocacy organization called Institute on Medicine as a Profession. (IMAP) with a 7.5 million dollar grant.

Later two grants ($350,000 in 2003 and $ 60,000 in 2008) was  given to IMAP by the ABIMF.ABIMF is chiefly funded by the ABIM and has a common leadership roster.In turn ABIM makes its money by testing internists and managing their Maintenance of Certification (MOC) program,a program that has generated a firestorm of protests from practicing internists and a serious effort to establish a rival means of maintenance of certification.

What is the ACP-ABIM(F) version of medical professionalism. Among other features, this "charter" calls for physicians to be "stewards of society's medical resources" and to work for social justice. It speaks of an obligation not only to the patient but to society as least in the sense of conservation of these allegedly common resources and to work for a just distribution of these resources.

The Charter was not cut from whole cloth, neither was it a tailored answer to the alleged problems that were claimed to be causing physicians angst  in the new millennium.Rather it was another manifestation or application of the new Bioethics about which Pope Benedict XVI had this to say in his 2010 address to the Pontifical Academy for Life:

"Under traditional medical ethics the guiding principle is 'do no harm". But contemporary bioethics abandons this in an effort to find the utilitarian goal of the greatest good for the greatest number Under these principles preserving the life of the human patient is not considered paramount."

Wait. what  does the charter have to say about greatest good for the greatest number? Explicitly it said nothing but advocating social justice.

Social Justice is a loose , vague and indeterminate term, which although it has a useful rhetorical value   might puzzle physicians as to how they might actually work for the nebulous social justice in their everyday practices. The ABIMF in its publications and on its website made it explicit -follow the guidelines. In that way they claim  resources would be wisely distributed and fairly  thus furthering social justice. Here we get the greatest good for the greatest number in the collective. The collective may just be the HMO or ACO or possibly all members of society.So while the Charter seems on the surface to be medical ethical Principlism , a la Beaumont and Childress, underneath there is a strong utilitarian initiative .

ABIMF's mission appears to be to further this brand of medical professionalism and to
champion the "Choosing Wisely" initiative.

 The Soros funded IMAP describes its mission in the following way:
Their vision of medical professionalism  embodies 4 values;

1) altruism that is a unwavering commitment to the patient.
2)Physician Self regulation
3)Maintenance of technical competence-a commitment to life long learning
4)Civic engagement "Physicians should enlarge their scope of concerns from the welfare of the individual patient to a concern for the welfare of all patients" ( my underlining)

This parallels the outline of the Charter which continues to speak of duty to the patient but an additional obligation was grafted on to that traditional prime directive namely to conserve resources and work for an efficient and fair distribution of resources.Numbers 1,2, and 3 add nothing to traditional medical ethics but number 4 is another matter.

So IMAP more or less recapitulates the Charter blending the traditional mom and apple pie medical ethics with a new obligation to work somehow for all patients.It should be no mystery why ABIMF might share some of its resources with another advocacy group with similar if not identical goals. My question is why does Soros wish to promote the new professionalism i.e. the Charter ?

So here it is- the physician's goal should not just be the welfare of her patient but rather the welfare of everyone.And the best way she could accomplish that goal is to follow guidelines which will provide the best bang for the buck (efficient "parsimonious care") .And one way to save money is  to limit care to the elderly which is being sold as improving the quality of life in folks in their twilight days and months.

One of the leaders in the effort to limit care to the elderly , Dr.Joanne Lynn,perhaps said more that she intended when she said:"Not only the right thing to do, it makes good business sense".

Good business sense, is that what Choosing Wisely is all about?And whose business are we talking about.

 Addendum: 4/1/16 Minor changes in wording made.

1 comment:

Walter Bond said...

Another great piece on this important topic.