Doctors should not pretend that they are experts in how society should be run.
Dear All ... Thank you for taking the time to write.
Yes, it makes perfect sense that MDs would have an important say in access to care via coverage. The main points I tried to make were that the more distant from our mission of health provision and the less we know about a policy (MDs are not training in economic policy), the more questionable our involvement becomes. Is it a wise trade-off, then, to take energy we take away from patients.
As for specific, partisan legislation, some could argue that it is worth the AMA taking a stand. The AMA did that with the ACA and got burned (lost membership and was seen as politicized). I think that organizations purporting to represent all doctors, should stay away from endorsing legislation. MDs can do that as private citizens or form interest groups (there is already Physicians for a National Health Program). Sure, they policitized themselves even then but they are not presuming to represent all doctors. Thanks again to everyone for responding to the piece.
Dear David O - much appreciated.
This debate mirrors exactly the attempts of the SJW to make social justice issues a part of the science policies needed to combat climate change. Social justice and science policy must be kept separate for these reasons: social justice is an ARBITRARY concept, based on political ideology, and as such is open to debate,dissent, definition and alternative proposals. Science is based on objective evidence, confirmation, replication and eventually consensus and is NON ARBITRARY. To rely on social justice ideology to solve scientific problems would be like relying on superstition and conspiracy theories rather than on doctors and medical research to combat the corona virus. A public consensus on social justice matters would take too much time to be found and implemented in any case, and failure to involve the public would take into the Stalinist realm of the last century, where political ideology supplanted impartial science and Lysenkoism threw the soviet union into scientific Dark Ages.
Thank you for the article. I greatly appreciate views that don’t toe the line of the liberal left and so offer a broader educating view.
I don't think we disagree, but the subtitle of your article is provocative : "Doctors should not pretend that they are experts in how society should be run". We don't "pretend" we are experts when we, for example, ask parents during a well-child check if there are any guns in the home and how they keep things safe. However, this has been construed (in Florida, for example) as an overly intrusive and political question to ask. We don't "pretend" we are experts when we question the wisdom of reduced Covid-19 testing to only the sickest people. And we don't "pretend" we are experts when we question the value to society of allowing fully 30 million people to be uninsured, thus guaranteeing heavy burdens on ERs and the rest of society which needs to foot this bill. So my point is that we physicians have direct experience of the ways in which social policies affect people's health, and it would be negligent for us not to communicate these views. We do not really have time to "implement" policies, merely to advocate for reform. Couching us as "pretenders" is harmful, demeaning and denigrating to people who have devoted their entire lives to trying to improve humanity.
Hmm. I have been substantially exposed to the health care systems in the United States, Australia, and The Bahamas. Some of Dr. Satel's points ring true, but she seems to draw a boundary that is too tight. I expect we would agree that, for example, when Sydney emergency room doctors took a strong stand on closing hours for nightclubs, having seen the drunken carnage spill into their ERs for far too long, that was an appropriate extension of their professional expertise into the political arena. There are many similar examples.
But what about issues such as universal health insurance? Does it not make sense that a doctor with years of experience in the grotesque world of American health insurance, particularly if that doctor understands how every other developed country does it better, would have a considerably more informed view than most other participants in the debate? Having seen patients denied treatment due to insurance coverage problems? Having seen patients, collectively in their millions, bankrupted due to medical bills? Having to treat patients far too late, because the patients were afraid of the costs of coming to the doctor? Obamacare, medical insurance, single payer, and the like are well within the professional competence of many U.S. medical practitioners.
Regarding anti-racism training and the like: there is a substantial literature of research-validated findings that doctors vary their treatment based upon the race (and sex and class and age...) of their patients. Reducing these biases is clearly a fit topic for med school training and for the professional colleges in continuing professional development.
On the other hand, much of what passes for anti-racism training now seems to be cant and bluster, so Dr. Satel has some good points to make there. One point that seems unduly contentious is that, while race may be a social construct, ethnicity is not, and difference ethnic groups sometimes vary in their disease concentration, response to medicines, etc. It would be a great tragedy if knowledge of these variances was suppressed to to misguided anti-racism training. Similarly, doctors are also attuned to differences in patient compliance across various groups, and that knowledge needs to be incorporated into training and development.
To back up Charles LIttrell's response where he states:
But what about issues such as universal health insurance? Does it not make sense that a doctor with years of experience in the grotesque world of American health insurance, particularly if that doctor understands how every other developed country does it better, would have a considerably more informed view than most other participants in the debate?
Noting that Dr Satel is connected with the conservative American Enterprise Institute, it would be interesting to hear her views on universal health insurance. She will have to be very careful to toe the line for AEI. How would she defend the waste and expense of the current system and its non-coverage of the bottom 20%? Profit-making insurance has to avoid this group like the plague, but in the process, endangering the rest of the population with the danger of a real plague--say a Corona Virus on steroids coming from those with little or no insurance.