“We can destroy ourselves by cynicism and disillusionment, just as effectively as by bombs."
This observation, from the late, great British historian Kenneth Clark, could be a warning sign to the medical profession. Some of the more incendiary commentary in blogs, editorials, and medical publications today display the classic characteristics of cynicism, which is a profound pessimism accompanied by a deep distrust and even the disparagement of the motivations of others. Physician cynics not only direct their anger at the usual suspects – members of Congress, insurance companies, and government “bureaucrats”—but even at their own colleagues, including the leadership of their own professional societies.
Now, to be clear, I am not talking about principled disagreement and debate over the best policies or course of action, which is good and healthy. It is only when such disagreement becomes “personal”—assuming the worst motivations of others, even when you don’t personally know them—that it becomes the type of self-destructive cynicism described by Clark.
Take the cynics’ charge that the leaders of physician professional associations, including ACP, are living in “Ivory Towers” disconnected from the “real world” of practice, and that they “sold out” the rest of the medical profession by their actions. Really? I know many of these leaders, and they are as grounded in the “real world” of practice as anyone, but with one crucial difference: they are taking time out of their busy lives to help make things better for their colleagues and their patients.
On Sunday and Monday of this week, two of ACP’s key policy committees met in Washington, D.C. Want to know who they are and what they do? The Medical Practice and Quality Committee, which recommends ACP policy on payment and delivery system reform, has 13 members, eight of whom are in private practice (two of them in solo practices!), one is a medical student, one is an internal medicine resident, one is a chair of a department of medicine, one is an assistant professor of medicine, and one is a medical director for a large group practice that has its own associated health insurance company. The Health and Public Policy Committee, which recommends ACP polices relating to workforce and health insurance coverage, has 13 members, four of whom are in private practice, one is the CEO of a medical college, three are professors of medicine, one is an assistant dean, one is a chair of a department of medicine, one is a medical student, one is a hospitalist, and one is an internal medicine resident. Also attending the meetings was the chair of the Board of Regents (private practice doctor) and the ACP president (a professor of medicine).
Then there are the almost 400 medical students, IM residents, and physician members from all types of internal medicine practice and parts of the country who took a minimum of two days out of their busy personal and professional lives to participate in ACP Services Leadership Day on Capitol Hill. If cynicism is the poison, then engagement in trying to make things better is the antidote. Unlike the cynics, these physicians have decided to address their shared frustrations with the state of medicine today by learning about the issues, politics, and policies—from administration officials, ACP staff, members of Congress from both political parties, congressional staff from key health committees, and from a well-known cable TV political analyst—and then to walk the halls of Congress to seek support for ACP’s top legislative priorities.
And this is why that I don’t think that Kenneth Clark’s warning predicts the future of the medical profession. Yes, cynics get a lot of attention, but there are many, many more physicians who are grounded in all of the glorious diversity of internal medicine practice today, who understand that the best way to achieve change is not to reflexively dismiss the ideas and the motives of others, but to engage in the political process through their professional associations for the betterment of the profession and the patients they serve.
Today’s question: Do you think Kenneth Clark’s quote predicts the future of the medical profession?