Tuesday, November 2, 2010

Apple pie, attack ads ... and a return to civility?

Well, it is almost over. By the end of today, we should see a (temporary) end to the onslaught of negative campaign ads that are poisoning the well of political discourse. Hallelujah!

As bad as it has been, over-the-top attacks on your political opponents are "as American as apple pie" says Reason magazine's bloggers. The libertarians at Reason have used actual quotes from Thomas Jefferson and John Adams and their supporters to craft some very funny modern-day candidate attack ads. The 1:43 minute You Tube video starts with comments from TV reporters and President Obama decrying the negativity of this year's campaign, followed by made-up - but historically accurate - campaign ads "from" Jefferson and Adams.

According to Reason, Jefferson really did call John Adams a "blind, bald crippled toothless man" ... "who secretly wants to start a war with France" ... "while he's not busy importing mistresses from Europe." Adams' supporters predicted that if Jefferson was elected, "Murder, robbery, rape, adultery and incest will be openly taught and practiced, the air will be rent with the cries of the distressed, the soil will be soaked with blood and the nation black with crimes." Makes the Sharon Angle/Harry Reid slug-fest seem tame by comparison, doesn't it?

It is reassuring in a way that personal attacks on opponents go back to the earliest days of the Republic. Yet I worry that the 24/7 media amplification of negative attacks have coarsened our political culture, making reasoned dialogue close to impossible.

And it is one thing when politicians engage in a Mud Fest, but should physicians be held to a higher standard of political discourse?

Yes, says Dr. John Tooker, who recently retired as the Chief Executive Officer for the American College of Physician. (Dr. Tooker continues to serve in an advisory capacity for the ACP.) He blogs on KevinMD that ACP's ethics manual calls on physicians to "work toward ensuring access to health care for all persons; act to eliminate discrimination in health care; and help correct deficiencies in the availability, accessibility, and quality of health services, including mental health services, in the community."

"These very patient care issues - access, discrimination and quality of care" he says, "were front and center in the recent national health care reform debate, to the credit of the physicians that fully engaged in the debate, whether one agrees with the final Affordable Care Act legislation or not."

Yet physicians did not always express their views with the civility, says Dr. Tooker:

"Unfortunately, during the political conversation within our profession, there were also instances of incivility - remarks and statements made by physicians that went beyond the bounds of decency, and at times were perceived as threatening by the recipients of the comments. Instant and reflex electronic communication facilitated such comments - hitting send before thinking twice or thrice - and the opportunity for civil discourse was lost."

He argues that, "Policy makers and politicians are looking to physicians to provide leadership at every level. Because of the standing based on moral principles and education that physicians have within our society, there are and always have been great leadership opportunities to improve the care of our patients and the satisfaction of our profession. If we don't act professionally, we diminish our standing and ability to lead."

Dr. Tooker closes with a reference to another founding father. "There is a small but revealing book, Rules of Civility, by Richard Brookhiser, that describes the moral code that guided George Washington as the first president of our republic during very difficult times. The first rule is: 'Every action done in company ought to be done with some sign of respect to those that are present.'"

Amen! I hope that Dr. Tooker's admonition is something all of us - physicians and non-physicians alike - take to heart as we express our views tomorrow on the results of today's election.

P.S. I was humbled to learn that the ACP Advocate blog has been recommended as "one of the top 10 health care bloggers we are thankful for" by a company that describes itself as a leading source of health management news for 50,000 health executives. I was especially heartened that they characterized the blog as managing "to offer calm, level-headed commentary on topics that often can lead to superheated, highly polarized debates in other forums." Exactly the type of civil discourse I seek to encourage!

Today's questions: What do you think Jefferson, Adams and Washington would make of today's political discourse? And do you think physicians should be held to higher standards of civility, as Dr. Tooker argues?


ryanjo said...

Although I seldom agree entirely with the ACP Advocate, I commend him for a maintaining a blog dealing with controversial topics and allowing posters to express opposing points of view. And actually responding directly to them.

Regrettably, this is not a universal policy at ACP. The recent KevinMD post by Dr. Tooker reveals the more standard approach taken toward dissenting ACP members: a) the debate on health care reform is over, and b) anyone who continues to raise objections is either opposed to "access to health care for all persons" or even "beyond the bounds of decency" -- if the competence, foresight and fairness of ACP's actions in supporting the ACA is challenged. Dr. Tooker makes no apologies for the lack of progress with SGR, token measures on liability reform, and threat to fund ACA by reducing Medicare by half a trillion dollars, likely using even more audits, preauths, delays in payments and other abuses now imposed on his fellow physicians.

Likewise, Dr. Luke, Chair of the ACP Board of Regents, and ACP President Dr. Ralston were outspoken in their defense of Dr. Laine, the Annals editor responsible for the much maligned "Affordable Care Act and the Future of Clinical Medicine" article, predicting the demise of small group private practice, but provided no opposing published viewpoint. I can read between the lines: "ACP wants small practices to participate in the changes coming with the ACA" (so please die quietly, and without "incivility"). Many of us would value an equally vociferous, consistent, continuing and public message that the implementation of the ACA without payment reform, liability relief and reduced administrative burden will destroy the small physician practices that presently serve 80% of Americans. Feel free to blog about that anytime, gentlemen. Or even speak to the media.

Reading through the comments on Dr. Tooker's blog on KevinMD reveals that the debate is not over. And when the lame duck Congress returns and fails to reverse the SGR as many expect, I hope to hear from our national physician leadership. Even if it takes an attack ad or two. I think George Washington said it best: "Government is not reason, it is not eloquence, it is force; like fire, a troublesome servant and a fearful master." Let's fight fire with fire, not whimpers.

DrJHO7 said...

"civility": I wonder if that is the approach that physicians should take when communicating the impact that the SGR related cut in physican payment under mcr (23%, as of 11/30/10) will have on the private medical practices that are the guts of our medical system, and access to care for mcr patients. I doubt this, or most other approaches, will capture the attention of a lame duck congress.

I just paid off the line of credit i borrowed from my bank at the end of June to make payroll in July, thanks to the less significant cuts which occured in June, and delayed all mcr payments for almost a month.

Today, I was on the phone to our two senators' offices in DC about this issue. One said "it's an important issue for the senate, but it's unclear if there will be any action on this in the next short session." read: wait til january, endure the cuts, again, only worse and for longer.
The other senator's office was indifferent, since he will not be returning to office, seems it's the next guy's problem.

So, we'll have january to look forward to, when the cuts are even deeper, 31%. The mantra of the new bold and brazen House of Reps as of last night is: "no compromise", particularly on issues involving spending. Now that the SGR has metastasized into something that is too big to solve,
it'll be interesting to see how our new congress tackles this issue
as the ACA kicks in further, and as incentive programs for EHR's under ARRA/HITECH start to roll out.

As I borrow twice as much on my LOC to get through December and January as i did in June, I wonder how we, as a profession, will effectively garner the attention of our elected officials to wrestle with this SGR/pay cut issue, again. I doubt that it will be through civility.

I suspect that it will take an outright demonstration of anger on the part of physicians - leaving the mcr program in significant numbers, to seek other financial models for their practices to survive. The access to care issue for mcr patients will need to become hyper-acute enough and on a broad enough scale that the media and the public become aware of the problem, and congress is then forced to deal with it as a priority issue.