Memo from the Editor

August 5, 2005

Society asks a lot of you

Whatever the reason you went into medicine, I bet it wasn't because you wanted to solve society's problems. Yet over and over, that's just what you're asked to do.

One of the most recent attempts to enlist physicians' help-and maybe the one that stretches the boundaries the most-is the request from HHS last year that doctors "be vigilant in looking for potential victims of human trafficking . . ."

Why you? It seems that the Trafficking Victims Protection Act of 2000 hasn't done much good. With estimates of the number of such victims approaching 18,000 a year in the US alone, there have been only about 700 people who've sought the protections offered by the act. And it seems that healthcare is not denied these victims, even if freedom is-the traffickers need their "slaves" healthy so as not to lose their investment.

As it turns out, a number of the signs that a person may be held in bondage are the same signs you'd look for in a victim of domestic abuse: The patient has bruises or other signs of battering, is always accompanied by someone, rarely speaks for him-or herself, and seems insecure or afraid.

Of course, your enlistment in the fight against domestic abuse, though of longer standing, is another case of asking you to solve a societal problem. (As long as you're being asked to fill a watchdog role, we provide information to help you do that in "Domestic violence: Shattering the silence.") You're also asked to spot-and in many cases are legally responsible to report-child abuse, elder abuse, and substance abuse. You're supposed to pick up subtle signs of depression, suicidal ideation, eating disorders, and a host of other psychological problems that are not easy to detect during the average visit for an upper respiratory infection.

Is the nation asking too much of you? How do you respond? Do physicians opt out, letting the nation know that it's unfair to put these burdens on you? That's certainly one way to go, but I don't think it will happen. Because whatever the reasons you entered medicine, I believe that one of them is the desire to help ease suffering.

All I can offer, then, is the promise to help you fulfill the expectations society has of you and a sincere "Thank you" for shouldering the burden.