Memo From The Editor

Have we changed?

Marianne Dekker Mattera

I sit down to write this memo having just returned from the Annual Session of the American College of Physicians-American Society of Internal Medicine, held this year in Philadelphia. Although there was no way I would have been able to talk to each of the 5,200 or so physicians who attended the meeting, I do love being able to say hello to many loyal readers when they visit our booth in the exhibit hall or when I sit among them at sessions. It's nice to hear in person from people who invite you into their homes or offices every issue.

Even more important, though, is the fresh perspective I get on the readers I serve by walking among them for days at a time. Days when all of us are freed from the daily routine and placed in a learning, collegial environment. You tend to see things differently, to focus on issues you haven't found time for, to remember why you do what you do. You have time to think the big thoughts.

One of those big thoughts has been rolling around in my head for some months now—have we truly changed since Sept. 11. I heard it being spoken aloud by Dr. Walter J. McDonald, the ACP-ASIM Executive Vice President and Chief Executive Officer in his keynote speech at the opening ceremony.

He asked whether the profession of medicine has changed as a result of the events of the past year, including in that time frame the economic downturn as well as the terrorist attacks and the anthrax scare. He acknowledged all the obvious personal changes—anxieties about flying, the urge to spend more time with our families, the realization that we are vulnerable and that our lives are influenced by events and people far from our shores.

But McDonald's ultimate answer to the question was No, the profession has not changed. Because there was no need to change. "The events of the fall of 2001, while horrifying, have presented us with new challenges, but do not qualify as events that will change the basic qualities of the medical profession and those who practice it," he said. "Within the principles and commitments of the profession, one can find the appropriate responses to all of these challenges and any others that might present."

I couldn't agree more. Early this year, the ACP-ASIM, along with the American Board of Internal Medicine Foundation, and the European Federation of Internal Medicine, set down in writing a series of principles and obligations of medical professionals. They'd worked to develop this Charter on Medical Professionalism, as they call it, since 1999 because they felt a need, amidst so much turmoil in the health care arena, to reaffirm the principles to which physicians have traditionally been committed.

As spelled out in the charter, they are three: the primacy of patient welfare, the importance of patient autonomy, and the need to promote social justice in the health care system.

The obligations to which these principles hold physicians include commitments to professional competence, to honesty with patients, to patient confidentiality, to maintaining appropriate relations with patients, to improving quality of care, to improving access to care, to a just distribution of resources, and to scientific knowledge.

Dr. McDonald is right: None of these principles or responsibilities have changed since Sept. 11. Any action physicians have been challenged to take—from organizing medical care at the scene of the disasters to educating patients about anthrax to advocating for and participating in a more robust public health effort in this country—fits perfectly in one or another of the tenets set out in the physician charter. (Which, by the way, applies to all physicians, not just internists.)

Have we changed? I, too, say No. Unless by change we mean getting back in touch with who we are at the very core on a professional level as well as a personal one. If that's the definition of change, then we better do it quickly.

 

Marianne Mattera. Memo from the Editor: Have we changed?. Medical Economics 2002;9:7.