United States Code: Title 42,1395. Prohibition against any Federal interference | LII / Legal Information Institute

United States Code: Title 42,1395. Prohibition against any Federal interference | LII / Legal Information Institute

The above reference is the actual first paragraph of the Medicare Law which was passed in 1965. It is clearly an example of the extension of control that results when the Federal government "moves" into an area of public interaction. Even the title is, unfortunately, a lie: "Prohibition Against Any Government Interference. " Please follow the above link, and read the paragraph.

It is a fact, that the Federal government totally controls (or interferes) with the delivery of medical care. It controls admissions, discharges, payment to all involved, and rules, rules, rules. There are career ending "threats" if you don't obey these rules, and overall it has become an oppressive system for all "providers."

There are many reasons physicians are losing--or have lost-- their Professionalism, but the above departure from this earlier "promise" is pivotal. Society shouldn't want physicians to lost their distinction as "Professionals" for if they lose it, when someone is sick and in need of a physician's help their will be the feeling that you were treated with the same level of compassion as a customer ordering a hamburger at the McDonald's take out window.  Not a pleasant thought!

I think it is important that we remain vigilant  of this departure from government's original promises when Medicare was passed, and its eventual control of the system. Didn't we just pass a "drug benefit"?  Where will the "control"of the pharmaceutical industry be ten years from now and how will it affect the pharmaceutical industry. Keep your eyes open.

Reunion and Change

I went to a 40th Class Reunion this weekend. Its been forty years since I graduated from medical school. It doesn't need to be said, but those years went by in an instant: marriage, children, internship, moving, residency, first job, residency again, moving, and then the long run of my most "productive" years of work. It goes by too, too fast.

Sometimes it was difficult to recognize those classmates who accompanied me on that educational journey of a lifetime- too much time had taken something away from them. Some could hardly recognize me either. We visited the rooms and laboratories that we haunted 40 years ago. I always get an inexplicable feeling about the passage of time when I visit a place I have not been to in years. I just don't understand where the time goes, and why everything looks as if it has not changed much even though all this time has passed. Remembering the chemistry, physiology, anatomy labs with all the struggle, and learning and discovery inspires one to reconsider what actually happened. A lot of growing happened during those years.

During the weekend we went to lectures, and dinners, and visited each other after a 40 year hiatus. I recalled that my medical school filled me with information galore, but it also filled me with a professional ethic that has carried me far into my surgical practice. It's the PATIENT FIRST. That's the "old time" professional ethic. It was a pleasure to be with 35 of my classmates who understood their calling the same way I have understood mine for all these years. I know times are different now, but when we graduated in 1969, the majority of us were not thinking about "life style" we were just going to be physicians-that was our "life style" choice.

The only discouraging experience of the weekend, was the lecture by the person who tried to teach us about "Medical Education in the 21st Century." Why discouraging? The message was that my generation was gone and out of touch. The new generation was concerned about their "lifestyle:" how much time they would have with their family, how much less work they would have to do, how short their work day would be, and possibly how much they would earn. I got the feeling they didn't want to work the same way we did. I worried about their understanding of Professionalism.

Now I don't want to criticise the younger generation, be it x'ers, or the me generation, or whatever, but I worry that this "life style" choice is a reflection of a deeper motivation that threatens the essence of what it means to be a physician.

An essential purpose in all of our lives is the positive effect we can have on others we encounter. Physicians have the privilege of working in a milieu where we can satisfy this need. We do it by becoming "professional."

According to Dr. Edmond Pellegrino, of Georgetown University, professionalism in medicine is played out on the stage of the physician-patient relationship. The patient comes to us vulnerable, frightened, confused, and in need, and for the physician to satisfy that need, we must have an ethic of self effacement, and sacrifice. This is the essence of professionalism. A "life style" choice does not seem like a creditable start towards this goal.

There are many forces in medicine today that are threatening professionalism and driving a wedge between the patient and the physician. I do not know what the result will be if the younger generation of physicians loses sight of the necessity of self effacement and self sacrifice as they enter this special field. Caring medicine cannot survive without a professional commitment of its doctors. I hope the younger generation can learn that professionalism in medicine requires a commitment to the patient that can hamper one's "life style." Unfortunately, that's what it takes to be a doctor.

James P. Weaver,M.D.,FACS