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EditorialAre We On The Right Track?Niranjan Kissoon, M.D., Editor |
Sir William Osler, arguably the most esteemed physician in the history of medicine, told his students: "You are in this profession as a calling, not as a business; as a calling which exacts from you at every turn self sacrifice, devotion, love and tenderness to your fellow men. Once you get down to a purely business level, your influence is gone and the true light of your life is dimmed. You must work in the missionary spirit, with a breath of charity that raises you far above the petty jealousies of life." These sentiments so elegantly expressed have provided the moral underpinnings of medical practice since the Scottish Philosopher Dr. John Gregory proposed the concept of medicine as a profession in its ethical sense: the physician as moral fiduciary of the patient. Sir William Osler reiterated this sentiment by citing the caution that "no one should approach the temple of science with the soul of a money-changer." Today we are all under severe financial constraints in which the managed practice of medicine has created conflicts of interest in how physicians are paid with respect to job security and job advancement. In addition, managed practice regulates clinical judgement, interferes with decision making and restricts the autonomy of patients. These approaches have commonly placed the ethical physician in an adversarial role with managed care. The question arises: can we still achieve what is best for our patients and ourselves using the Oslerian philosophy? Detractors believe that trying to recapture medicine using the Oslerian philosophy is doomed to failure since these views are outdated. The climate is harsher and therefore, a radical approach is needed to extricate us. Proponents of a new strategy often refer to Einstein's admonishment that we cannot solve a problem using the same thought patterns that created it. Advocates of Osler's approach counter that apathy and lack of foresight rather than being a moral fiduciary landed us in this mess. Osler's disciples have challenged naysayers to provide a better alternative. I firmly believe that there is no alternative. We must assume the mantle of moral fiduciary if we intend to be worthy of the public's trust and support. Fortunately, help is within the reach of even the unenthusiastic and skeptical among us. While business tools employed today have the potential to create ethical problems in the care of patients and management of healthcare institutions, we can prevent these ethical problems by using a preventative ethics approach. This entails the healthcare profession and institutions acting as the economically disciplined moral co-fiduciaries of patients. We should act primarily to protect and promote the interest of the patient, blunt self-interest and expect economic and other forms of self-interest to be fulfilled. The tides will surely change under the sheer weight of our moral stance. As Sir Thomas Hobbes states, "The value or worth of a man is, as of all things, his price." We can determine our own price. I humbly submit that practitioners of Osler's philosophy are still on the right track. Jacksonville Medicine / March 2000What's New
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