NEW ORLEANS— The “deprofessionalization” of medicine is the greatest challenge faced by physicians today, Glenn D. Steele, Jr., MD, PhD, said in his presidential address at the Society of Surgical Oncology (SSO) Cancer Symposium. He implored his colleagues to get back on the “high road of first principles” in order to tackle the problems generated by managed care and and other aspects of the current health care climate.
Dr. Steele is Dean of the Division of Biological Science, Pritzker School of Medicine, and Richard T. Crane Professor of Surgery and Vice President for Medical Affairs, University of Chicago.
Dr. Steele said that past SSO presidential addresses have made “critical assumptions about shared values.” Rather than rely on such assumptions, however, he urged more openness and discussion about professional values. Shared values, he said, can serve as antidotes to the problems now faced by the profession.
Core values derived from physicians’ interactions with patients, colleagues, and students should provide guiding principles, he suggested. Articulating and espousing core values should take precedence over adapting or “aping” other value systems.
And he stressed that physicians must be willing to step into leadership positions, to help influence the ongoing attempts to redefine “professional.”
Understanding the Issues
As physicians must differentiate the symptom from the disease when treating patients, so must they differentiate the true problems they face from the symptoms that the problems produce, Dr. Steele said.
For example, lower reimbursement for services rendered is the symptom of a more complex “disease” that is characterized by the increasing demand for care and access, the medical profession’s improved ability to “heal,” and the lack of political consensus on how to pay for rising health care costs and whether and how to ration care.
In a nutshell, he said, the “big problems” span many areas: resources, education, leadership, information, and “what’s best for the patient.” He asked, “What shared experiences have honed our core values and what might help us deal with—though not necessarily solve—these big issues?”
Redefining the Profession
Uppermost among the physician’s core values should be the “privilege of patient contact,” Dr. Steele said. “Unless we consistently deal with our problems by framing them in terms of the individual physician/patient relationship, we will dilute the ‘bargain’ we have with patients that keeps our profession from being redefined as a guild, estate, or perhaps simply an important trade.”
Already, he said, the market model of medical care “has obliterated distinctions between business and medicine.” Other role models are being forced upon physicians—business executive, “faux-CEO,” hourly worker, and so on—but, Dr. Steele stressed, none of these models affirms the patient/doctor interaction and, in fact, some even demean it.
“The redefinition of doctors as providers and patients as consumers is equally insulting to both parties,” he said.
Dr. Steele also said that caring adequately and compassionately for the individual patient does not have to be incongruous with what is best for the larger community, even in a managed care environment; and that one way of partnering with patients is by including them in clinical trials, which also serves to move the practice of surgery forward.
He concluded, “How we are perceived by our students and by society will be determined by how well we adhere to our values, how well we articulate them, and how these values are judged to benefit those outside of medicine.”
