The Conscience of a Vice-President

¹ 869 Madison Avenue, Memphis, Tennessee 38104

If, now, in closing, we pause and look at most of our major problems, except for the problems inherent in the growth of our Academy, we find two common threads running through most of them: namely, our failure to communicate with the public and the ever-increasing government interference and regulation. Undoubtedly, many of our present frustrations stem from our inability to identify mechanisms for effective action to cope with these problems that are beyond our day-to-day patient-care relationships.

Whereas, for example, in the past we have sought more funds for research based on the merit of individual grants, we have now been made very much aware of the "real" world. To expand our musculoskeletal research program, we must enlist the support of the public in order to influence legislators that the expenditure of such funds is justified. Funding in the past has been proportional to the mortality figures. Trauma is now the fourth most common cause of death in all age groups and the most common cause in ages two to forty-four. But, we have not educated the public as to the mortality or the morbidity resulting from disease and trauma of the musculoskeletal system or the improved quality of life that can occur from new and better forms of treatment and prevention.

Hopefully, a more informed public will help unravel the malpractice problem. Legislators and judges are swayed by what they sense is public opinion; public opinion is reflected by the settlements that juries award. I doubt that there is much public clamor for relicensure and recertification. It is the mass media and the results of misleading extrapolated data that harp on incompetence. And, whereas there are many poor results and untoward drug-reaction headlines, there are very few reports of the vast number of patients who now survive and do well. I am convinced that the increased cost of medical care will be the undoing of the practice of medicine as we know it; the solution requires the efforts of the so-called consumers, providers, and third parties.

Increased governmental involvement in health manpower, national health legislation, and various health delivery programs not only modifies the practice of medicine, but is part of the gradual erosion of our freedoms.

The defenders of a free society often seem to have virtually no public influence. The media barrage us with evidence that the free-enterprise system is not working, but fail to report that this is true because it is not allowed to work. Yet, we know that, without a sound base of public understanding and support, our institutions will continue to erode, and we will witness an ever-increasing concentration of power in Washington. Too often, the input of medicine has been non-existent, conflicting, ignored, or after the fact. How can we cope with increased governmental interference, suppression, and regulation? We must continue to be alert as to what is occurring in the Legislature and governmental agencies. This is no simple task. In addition to the many bills in the Legislature, it is estimated that there are 302 health programs administered by eleven different major departments or agencies. The Federal Register published 10,000 more pages of regulations last year, a 30 per cent increase over the previous year. Nevertheless, our political awareness and effectiveness must be sharpened. We must be on the scene more frequently, rather than appearing only when we have a vested interest.

For problems that encompass larger segments of medicine, we must join with other organizations. In general, this means the A.M.A. Many medical specialty societies, including our Academy, feel they do not have sufficient input into the A.M.A. The A.M.A. is a federation of state organizations, but recently several proposals have been made for greater specialty-organization representation that may increase our influence. The A.M.A. is the only umbrella organization structured to speak for all of medicine, and it is true that, if it did not exist, we would probably now be in the process of forming such an organization. When government is unreasonable, unfortunately relief can only be found in the courts, but fortunately, this is still a land of law rather than of men. What other group in medicine can successfully challenge the Federal government in court? The A.M.A. actions concerning Utilization Review, maximal allowable charges for drugs, advertising, and the Health Planning and Resource Development Act deserve our praise and support. What other organization is prepared to act on our behalf should the government attempt to declare medicine a public utility? It serves no purpose to accuse the A.M.A. for government encroachment upon medicine. It is my conviction that the A.M.A. merits the support of all physicians who believe in the free-enterprise system and wish to maintain the high standard of medicine in this country. We must not be disillusioned by what has occurred in the past nor be disenchanted by relatively unimportant differences of opinion. Different opinions shall always exist in large organizations. But, rather, we must be sure that we are actively engaged in attaining the main objectives.

Many of our problems in medicine are not peculiar to our profession. What has happened to medicine has also happened to business, education, and law enforcement. There seems to be a growing pattern for individuals to turn to government to do more and more for them. As a result, at least to some degree, the essential conditions of human dignity and freedom have been lost or are under constant menace. In the hands of those who claim tolerance, there is the power to oppose and obliterate all views but their own.

We know there is a need to sustain the concept of law and order and to foster the belief in private property, the competitive market, and a free society. Our twentieth century will be exalted in science books as the period of great scientific achievement, but, in the political history texts, it will be branded as one of a galloping government earmarked by remarkable governmental growth, unrestricted ideals, and deficit budgets.

This is not a time to despair, but to accept the challenge to do as much as our energies and resources permit us in influencing public opinion and legislation in order to avoid further governmental encroachment upon the practice of medicine, and to nurture and preserve the rights and freedom of all individuals.

Members and guests, ladies and gentlemen, I have presented "The Conscience of a Vice-President". As I stated initially, if you agree with me, I enlist your aid; if you differ with me, I solicit your thoughts.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?