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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 ...

Monday, May 02, 2016

Retired doc celebrates 1000 + commentaries with some self referential rehases.

 Happy anniversary to self.

About ten years and now  slightly over one thousand blog commentaries have passed by  since I started a blog about the same time I retired .

Here are some of my favorites topics , a few of which have had a few thousand hits which is a lot for a backwater blog with minimal general interest and too much inside baseball talk.

1)I have written about so called "high value" medical care more than once. Here is my favorite in which I suggest that while modern mainstream economic thought is very diverse and has many areas  in which there is marked disagreement, most agree that demand curves slope downwards and value is subjective. The now widely talked about notion of high value medical care seems to contradict that second principle.Simply put- the question is high value according to whom.

Another commentary on a related issue is here . Value=quality/cost as a pseudo-equation used to pretend that cost containment is really all about quality and has nothing to do with third party payers enhancing their profits by lowering costs, i.e. paying less for medical care.

2)Meta Analysis is a topic I have written about for ten years with my basic grip being that meta analysis should not be enshrined at the tip top of the evidence based medicine pyramid.See here .
I quote from from an important essay by Dr.  Steve Goodwin .

3)The issue of how to apply population data , as in for example a randomized clinical trial, to a real life individual patient, is a topic I wrote about in 2005 quoting heavily  from an important paper by Kravitz,Duran and Braslow  in one of a series of blog entries that were facetiously labeled  suggestions for a medical school curriculum. (Facetious because I had no role whatsoever in curriculum planning)

4) Another "curriculum suggestion" dealt with education about  the transformation of Nazi  physicians to Nazi killers.This quoted liberally from a book  ( The Nazi Doctors) by Robert J Lifton,M.D.  Lifton  said - That according to the Nazi medical credo the physician was to be concerned with the health of the Volk and was to overcome the old individualistic principle of the right to one's own body and the embrace the duty to be healthy and the physician duty was to the collectivity.( a paraphrase not a direct quote). Scary ideology that did not  die out with the end of World War II and what happened  and how it happened in Germany is an important thing for current physicians to know about.

5)A theme I have hammered away on perhaps too much is that of the progressive medical elite,the medical arm of the progressive mindset who believe that ordinary citizens are just not qualified to mind their own business and that the elite must  mind it for them , ideally by persuasion but if necessary through coercive means.Here is a sample. Some might use the term" medical clerisy" to refer to this group.

6) Little seems to be written now about the  Complete Lives System promoted by Dr. Zeke Emanuel that caused a bit of a controversy in 2009 . My critical commentary received more hits than most of my efforts as well a number of supporting letter echoing the concern I had.Here I suggest what Hayek might have said in regard to the complete lives system.

7) Physicians, like all humans, deal a lot with uncertainty One framework that can be used to consider uncertainty divides it into two types- stochastic or random and epistemic i.e. one based on lack of knowledge. Dr. Steve Goodwin offered a useful metaphor or story about the difference between random or stochastic  versus deterministic.  I wrote about that here.

8)Hoodwinking the medical profession ( and the public)  to further the boondoggle that medical practice is becoming  was the topic of a blog for which I borrowed heavily from a very insightful commentary by another blogger , Dr. Michale Accad.  The Baptist and Bootlegger metaphor is applicable here as well.

9 )The New Professionalism as envisioned by a subset of  folks at the American Board of Internal Medicine and the American College of Physicians with editorial and financial assistance from the Robert Wood Johnson  Foundation represents an effort to reformulate traditional medical ethics from which in which the physician has a primary fiduciary duty to his patients to one in which a nebulous duty to be a steward of society's medical resources assumes a major role and social justice is appended to the traditional medical ethical precepts.Here I comment on the relationship between social justice and the rule of law and here I write about  Thomas Sowell's Conflict of Visions
as related to the old and the new medical ethics.

Enough for one posting-maybe I reminisce about some others latter. 

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