On Physician Ethics and Professionalism

Before I can go further, I think it is imperative that we discuss the issue of Physician ethics and professionalism. I have read much lately about these specific topics, and I believe the public is confused. Indeed, even I have been confused at times with some of the very persuasive arguments I hear and read, many of them by doctors. Funny that such an ancient bond between the healer and the patient, has become so complex in these modern times. And then I pause and think to myself, if me or someone I loved were very, very sick, and depending on my doctors for the best advice, would it really be so complex? No I don't think so. In fact it would be crystal clear what really matters.

What is professionalism? Each profession or trade has a different ethical goal, and it will adopt or embrace certain virtues to achieve that ethical goal. The essential virtues are honesty, integrity and objectivity. In medicine, the goal always is the good of the patient. The primary virtue is trust.

As physicians, we cannot ethically accept limits of any kind on our judgments regarding patient care. Physicians are required to reject any scheme, however well-meaning, that comes between them and their patients. This means we can allow no third party to come between the patient and the physician, including third party payers. Such schemes are defended as necessary for the "good of society," and that may be the case, and physicians can get swept up in this argument. But because the good of the patient is the highest goal in medicine, the "good of society" cannot be the physicians' primary goal.

Again, this can be complex when you try to think it all through, but back up and put yourself in the position of a seriously sick patient. What does the "good of society" mean to you when you think about your child lying on the bed with an appendix about to burst. Nothing matters but getting that child to the operating room for surgery. And you expect your surgeon to be as single minded as you. Anything less, would be a breach of medical ethics.

This basic principal, is a validation of ancient Hippocratic ethics which have not changed at all in the modern practice of medicine. If anything, this "highest ethic" in medicine, is more applicable than ever as third party interference is ever present, and must be resisted, even if it means the physician is at risk of being fired, kicked out of a preferred provider panel, being economically de-credentialed from hospital staff, losing his referral base, or just plain being pressured to get out of town. And don't think this doesn't happen every day to one of the remaining doctors that hasn't sold-out to the suits.

This is why it is so important to know "who owns your doctor."

(Note: I have borrowed liberally from the comments of Jerome Arnett Jr., M.D, in this section)