Checkup

Vital Signs

The time has come

Dear Readers,

"The time has come for the public to be taken into our confidence; if we wish better results we must enlighten the people, for with them lies the final word."

"Our" and "we" in the above declaration refer to the medical profession, and as such the statement is self-evident. It's too bad that "we" have failed to fulfill the charge of the author, Dr. William Mayo, who uttered it exactly 100 years ago in a remarkably forward-thinking address entitled "The medical profession and the issues which confront it."*

Dr. Will covered a lot of ground in his speech, delivered in Boston in June 1906. Many of his remarks are as applicable today as they were a century ago. For instance, he was a strong advocate for public health education: "Society must be taught the early symptoms of cancer, the greatest foe of humanity, that its manifestations may be recognized while in the curable period."

In addition to educating the public, Dr. Will emphasized the need for physicians to continuously pursue their own education: "In the practice of medicine the student days are never over. There is so much to be learned that a long and industrious life leaves one with the feeling that he is but a beginner." He recommended that physicians should aim to spend an hour each day reading medical journals — excellent advice.

Dr. William J. Mayo

Dr. Will understood the power of potions, railing against unregulated medicines and nostrums that either provided no useful benefit or, in some cases, were deadly. Furthermore, he appreciated that the financial relationships between companies that make pharmaceuticals and the physicians who prescribe them can be an ethical minefield. Unfortunately, too many doctors continue to accept substantive gifts and favors from "drug reps" while asserting that they can remain unbiased about the medications they choose for their patients.

Dr. Will found it scandalous that some for-profit entities took advantage of charity hospitals by contracting for medical services at rates that were far below the cost of providing such care. It's not hard to imagine how he would feel about today's headlines, which describe how for-profit insurance companies hike their premiums, not to enable more reasonable reimbursement to those who actually provide care to patients, but to create multi-million dollar stock options for the company's executives.

Yes, the time has come for the medical profession to take the public into its confidence, to enlighten the people, for with you lies the final word.

As I've discussed in previous columns, it is becoming increasingly challenging to provide high-quality health care, the kind of care that patients expect and deserve. Doctors can and must serve as advocates for their patients, but ultimately it will be "the people," not politicians or insurance companies or malpractice attorneys, who decide how we as a society address the needs of the sick. On a more individual level, although modern medicine can perform technological feats unimaginable to Dr. Will a century ago, we can educate but not ensure that patients comply with our treatment recommendations or adopt healthy lifestyles, a topic I'll address in my next essay.

Sincerely,

George B. Bartley, M.D.
Chief Executive Officer

*JAMA1906; 23:1737-1740.