“Every institution is a womb, every boundary is a potential cervix and every change is a little birth. Groups react to threat with psychotic levels of anxiety. It is these underlying, primal fantasies at the international level which help explain the arms race. The group's boundaries carry the terror of the cervix. Out-groups threaten these boundaries.
Our memories reach back before birth and our stress at birth, with cranial pressure and oxygen deprivation, is a shattering and traumatic event for most of us. At a social level, whenever the circumstances unconsciously remind us of birth, for instance as at present, with high stress, low resources and rapid change, this primal trauma is reactivated: 'behaviour regresses, and is characterized by inter-group oppression, scapegoating, paranoid boundary controls and outbursts of anarchic system-destructive activity.'
-- David Wasdell, founder director of the Unit for Research into Changing Institutions (URCHIN), Docklands, UK
A civil society grappling with issues of equity and humaneness, in which health care is one of the most central concerns, desperately needs physician input and physician participation.”
-- David J. Rothman, Ph.D. and Tom O’Toole, M.D., “Physicians and the Politic Body”
An excerpt from “Physicians and the Politic Body”
by David J. Rothman, Ph.D. and Tom O’Toole, M.D. on the website, “Ideas for an Open Society.” From OSI-U.S. programs.
What is to be done? The capacity of the medical profession to resolve these dilemmas depends on at least two considerations: responsiveness to professional values and new commitment to advocacy. Let us spell out precisely what that would mean.
Physicians know well how to take care of patients. What is required of them is a broadened definition of what that care entails. It has to include not only gaming the system for one patient but advocating this patient’s general interests. Physicians need the skills and the commitment to translate their own feelings of frustration into an agenda of greater accountability from the profession itself, insurers, and society-at-large. Physicians must challenge a system of care that is structured on behalf of shareholders and speak out setting new national health care priorities. If the medical profession is to fulfill the covenant that exists between the doctor and patient, a new order of professionalism marked by advocacy and collective action has to emerge.
To this end:
- Medical schools and residency programs should reform the education and clinical training of physicians to incorporate advocacy and skill development and provide both a broader and more directed sense of professionalism and societal responsibility in the curriculum.
- Physicians must transform their professional societies into organizations that advocate on behalf of patients. Medical societies should not be in the pockets of corporate interests or driven exclusively by members’ financial interests. Infusing idealism and leadership within professional organizations can bring like-minded physicians together and give them a stronger collective voice. Models do exist, as in the case of the American Academy of Pediatrics and the Society of General Internal Medicine.
- Physicians must speak out on behalf of new health care initiatives to put a face to the story of health care inequity. Let them tell the media and the legislature what it means to feel a mass in a patient’s belly, recommend an immediate scan, and be told by the patient that there is no way he can afford it. Or what I means to diagnose a dangerous infection, prescribe the most effective but expensive antibiotic, and be told by the patient that there is no way she can afford it.
- Consumer and general advocacy organizations should break their own insularity and seek physician participation. Doctors can be powerful allies and they should be invited into the ranks of change-minded people.
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