Amidst the highly entertaining Wisconsin brouhaha, a sideshow controversy has emerged over whether doctors are writing “fake” excuses, and whether such should be their legitimate function. Seems a few motivated souls purporting themselves to be primary care docs were out among their fellows writing medical excuses; the history and physical component of which amounted to “Do you need a note?” and “Can you picket?” respectively.
Is this legal? Only the Wisconsin Board of Medicine knows for sure, or perhaps there are state laws governing such creative office practices. A greater issue for physicians is again raised: what is the proper “public” role for doctors? Apart from chat show doctors telling you to take a flu shot, surgeon generals telling you not to pork up, and the CDC keeping us safe from Ebola and zombie viruses, I get the creepy-crawlies whenever I hear colleagues pontificating over their duty to the public. It makes me want to go back to the source document, good ol’ Hippocrates. Reading the Classical Version of the Oath, one finds NO admonition for public service, or obligation to policy advocacy. But the world is a dynamic place for some, and perhaps the striker docs in Milwaukee prefer the AMA’s 2001 “Declaration Of Professional Responsibility”, which calls them to “Advocate for social, economic, educational, and political changes that ameliorate
suffering and contribute to human well-being.” So Prof. H told us how to act as individuals, and the AMA guides us in our actions a part of a mob, uh sorry, profession. That’s mighty high-handed talk from an organization dependent on government policy to squeeze cash out of their colleagues.
Neurosurgeon Dr. Ford Vox gives it a go in “The Atlantic” and sides right away in favor of teachers et al retaining their unionizing rights. Fair enough as politics, but how does being a physician lend extra credibility to supporting a collective political position? Dr. Vox notes family docs have been “advocating for our interests [by] battling insurers and administrators.” I wonder if he knows that recent family medicine board exams have included questions on Medicare compliance criteria? Further into the article we find that “three of the four” physicians cited on videotape for fake notes are doctor-faculty members at U. of Wisconsin’s Department of Family Medicine. I don’t know but have to wonder: are these faculty members simple altruists, or are they too unionized, and hence working for their own economic gain?
Emergency physician and medical ethicist Dr. Arthur Derse neatly summed up the controversy: “There is no question these doctors are masking political opinion in the white coat of the medical profession.” Of course they are, which then puts the glare on the state medical board. If they reprimand or discipline the doctors handing out fake notes, then they seek to uphold the special credibility believed by the public to reside in the medical profession, and in so doing will go athwart the wishes of their fellow state employees and unions. But if they turn a blind eye toward this medical fakery in the public square, then they send the clear message that their rules and standards are publicly traded coin, and that physicians are primarily political agents. Tough call.
Dr. Vox criticizes the “slapdash street encounters with apparently healthy protesters” as “(belittling) a public trust between physicians, employers and patients”, and demeaning to the doctor-patient relationship. Bravo, but wait! Isn’t that what doctors have been doing for over forty years via codes, prior authorizations, negotiated reimbursements, DRG’s, and the peddling of outrageously expensive ICD and CPT manuals as boundaries to care?
In the late 1990’s when serious welfare reform was considered, the U.S. Conference of Catholic Bishops got all lathered up over social justice and put their collars to a very definite public advocacy to the contrary; ditto every infrequent time a politician gets serious about controlling the border with Mexico. Are they less than priests, serving the individual American taxpayer less in favor of other approved groups? Are flim-flamming Wisconsin FP’s now more the agents of a special interest, and less the austere and esteemed guardians of the individual patient? They certainly have a well-established legacy to follow. Dr. Vox says of the spectacle, “The lasting damage is medicine's tarnished public image, and it is in that context that the Wisconsin Medical Society should craft a swift response.” I agree, but perhaps they should be a bit lenient. By throwing themselves out into the public in a heretofore unseemly way, the fake note writers are only continuing the trend of a realignment of the public’s view of the doctor as something and someone not so special after all.