Physician Patient

Archive for the ‘Message from the President’ Category

The Morality of Physician Professionalism

Tuesday, July 2nd, 2019

Andrew Abbott and his mentor Eliot Freidson help us understand the basis of morality for the medical profession.
Eliot Freidson wrote on the ethics and underpinnings of medical professionalism.
Andrew Abbott explains the evolution of medical professionalism in this excellent overview/analysis. Click on the YouTube video above from October 2011 at the University of Chicago. Passages (28 – 31), 33 – 40), and (46 – 55) caught my attention.
As we all know, big changes in medicine have occurred after WW II (for example UK NIH, 1965 US Medicare and Medicaid, and Obamacare 2010). Changes in the moral basis for medical professionalism are influenced by the identifying of medical care as a commodity, successes in public health practices, improved medical treatments, now dominating control of services and products by (government, insurance) third party payers, and the (growing) political claim that health care in America is a human Right. But who will pay for this? And how will mounting health care costs be mitigated and by whom?
The AMA now sees the doctor’s ethical role as a steward of scare societal resources (money):
But how can she do this without knowledge of the prices for health care services and products? And how can patients as consumers make prudent choices?
MPPA sees physicians as having a primary obligation to the health and welfare of their individual patients and applying Hippocratic ethics in patient care. If the doctor’s ethical loyalties are changing, how does the medical profession justify and enforce its ethics? What does the public think about physician ethics?

What are we thinking about Gender Dysphoria and Why?

Monday, June 24th, 2019

Katherine Kersten’s (June 21) Opinion article raises this important question: How can consumers (patients and families), taxpayers, and third party payers (employers, health plans, and government) evaluate the (growing) business of gender assignment, reassignment, and medical (hormonal) or surgical treatment for gender dysphoria? At Minneapolis Children’s Hospital a new program is doing this:

The motivation for professional gender dysphoria diagnosis and treatment may be altruistic, economic or other. But how scientific and clinically sound is this new business?

As a retired adult and addiction psychiatrist with no clinical experience treating gender dysphoric children (although I’ve heard concerns from a few of their parents), my chief concern is how the gender dysphoria diagnosis is conceptualized as a medical or mental disorder and the consequences to patients, the medical profession and society when our US health care system embraces “standards of care” such as
Society and politicians need to be informed about the ethical and economic underpinnings of the rationale by our major health care institutions such as Minneapolis and Boston Children’s Hospitals which now sponsor and promote insurance and government supported programs for hormone and surgical interventions geared to help gender dysphoric children (and adults). To my knowledge, these diagnostic assessments and treatments are based on psychological assessments of gender identity often in flux, as described by professor Eli Coleman at the University of Minnesota
Moreover, we need to know much more about the consequences of implementing these hormonal and surgical interventions on suicide and medical morbidity, and we we need to consider advice to the public (and professions) about “best practices” for psychotherapy. Beware of government edicts.
On what assumptions and evidence are crucial psychological assessments of gender dysphoria based? We should ask psychiatrists and psychologists in the academic and practicing communities  familiar with these questions to offer their recommendations.
We also need to ask the patients and their families about their experiences. Hopefully they will receive more and more social acceptance, more economic skin in the game, and more and better health care choices in the future.