Wednesday, March 02, 2011

Internists Remind Physicians About Universal Ethical Principles

Not sure how I missed this last week, but I was in the hospital all week putting a lot of hours and things were bound to slip by. Regardless, I did miss it, and thank RCentor at db's Medical Rants for posting it for all to see.

Last week the American College of Physicians (ACP), which represents 130,000 internal medicine physicians and students, released a statement speaking to the lapse of judgement demonstrated by the FP doc's in Wisconsin. The fact that this was addressed to the members of the ACP and not to the American Board of Family Practitioners does little to take the sting out of the blow. On February 28 the ACP "reminded physicians that professional ethics does not allow for them to sign off on false "sick notes" to excuse patients to engage in political advocacy purposes." This may not seem like much, but in the world of governing medical bodies, this is blistering criticism.

The full statement is as follows:

Internists remind physicians about universal ethical principles

PHILADELPHIA, February 28, 2011 – "Honesty is a core professional obligation and lying, even for a patient, is a breach of that obligation," J. Fred Ralston Jr., MD, FACP, president of the American College of Physicians (ACP) reminded all physicians, including the organization's 130,000 internal medicine physician and medical student members today.
ACP's statement was issued amid reported confusion surrounding "sick notes" issued without a medical evaluation to some protesters absent from work to attend rallies at the state capitol in Madison, Wis.
"This has most recently been discussed in Wisconsin, but it's not a state-based issue, like a state law," said Steven B. Pearson, MD, FACP, governor of the Wisconsin Chapter of ACP. "Rather it is a universal ethics principle on which ethics policy is based."
"Society empowers and trusts physicians to serve the interests of individual patients," Ralston said. "But physician authority and privileges also come with responsibilities to the community, even when individual patients want otherwise."
The 'sick note' situation is only one example of an array of ethical issues addressed by ACP in its Ethics Manual. The organization also develops policies and case studies providing ethical guidance and recommendations to help internists and their patients with many situations.
The American College of Physicians ( is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 130,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults. Follow ACP on Twitter ( and Facebook (

For more commentary along the same lines I refer you to Dr. Rich's Covert Rationing Blog where he discusses at some length his unique observations on lying physicians.
Instead, these doctors were, in a professional capacity, lying. They did not lie in any truly malicious way, however. They lied because they have been trained to believe in a higher cause than mere professional ethics, namely, the cause of social justice. They lied in full confidence that telling lies to advance such a noble cause is a natural duty of the medical profession. They never expected to be criticized for it (except perhaps by Rush Limbaugh and sundry teabaggers and the like), and they almost certainly will be stunned into indignant incoherence if they end up actually receiving the full punishments their actions allow.
But what really interests DrRich is the near-perfect silence we have seen from the mainstream news media regarding this sad episode. While it’s easy to find stories about the phony sick excuses all over Fox News and conservative websites, major outlets like the New York Times, Washington Post, CNN, CBS and NBC – sources one might expect to express at least some sympathy for these doctors and their work to advance a just cause – have reported next to nothing about it. When a left-leaning mainstream outlet does report on the episode (for instance, this article appearing in the Atlantic), rather than expressing any support for the Wisconsin doctors, they express at least mild dismay. It seems plain to DrRich that the mainstream media wish the whole thing hadn’t happened, and that perhaps their silence might help it go away as soon as possible.
So here we’ve got a small cadre of youthful and idealistic physicians, behaving in a manner entirely consistent with what they’ve just learned during their medical training, and not only are they facing formal investigations and potential punishment, but also the very people and organizations whom they were surely counting on for support have retreated into an embarrassed silence, or worse, criticism.
What gives?

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  1. >>So here we’ve got a small cadre of youthful and idealistic physicians, behaving in a manner entirely consistent with what they’ve just learned during their medical training

    This may be true given that the non-youthful, family medicine RESIDENCY PROGRAM DIRECTOR, Dr. Kathy Oriel was there with them writing the fake notes.

    This woman ostensibly gets PAID to teach the residents professional responsibility.

    This doctor herself knew that writing false notes was wrong, given that she said as much herself AT THE TIME, ON TELEVISION:

    "Dr. Kathy Oriel told ABC affiliate WKOW-TV in Madison that the doctors realize they could get in trouble for their offer."

    In other words, the residency program director knew this was wrong, but did it anyway.

    My question is that given her obvious lack of judgment here, why is she still residency program director?

    >>"We think its worth the risk," she [Oriel] said.

    Since she's apparently suffered zero professional repercussions for this breach of ethics, I guess she may have been right!

  2. I'm not sure that the scrubbing means the University has no plans for disciplining the doctors. It could mean that until there's a hearing and findings the doctors in question remain in good standing. I am an alum of the University and its law school and have asked for an explanation .

  3. cf, I agree that this doesn't mean that the administration has no plans for discipline only that it is curious that they would delete names and bio's as the furor erupted and replace them when they died down. The University has a real opportunity here. It would be unfortunate if they let it slip past. I am very interested to see if you get the explanation you are looking for. Any info you get I will be happy to share in this forum.

    Keep me posted if you wouldn't mind...

  4. Anon, of all involved Kathy Oriel bears the most responsibility. I have commented on it in other threads, but she should be terminated and made an example of. Regardless, that she knew of the risks and was willing to take them, she had no business bringing her residents with her, thereby sealing their culpability. Program Directors are supposed to protect their residents and she has intentionally put them in harms way.

  5. The unethical doctor's belief that it is moral for them to use the powers granted to them by their profession in the service of their own personal political agenda is very, very common on the Left. It influences the actions of academics, lawyers, journalist, judges and even scientist.

    Politics first, profession last, might be their motto.

    That is actually idea that originated with Fascist and Communist thinkers in the 1920s. For obvious reasons, such ideologies wish everyone's loyalties to be to the ideology first and foremost. During the 1960s Leftists academics imported that rebranded idea and have been indoctrinating all students with the idea that Leftist's politics is the highest good and the highest duty.

    For anyone on the Far (20% most) Left, it's a risible idea that a professional role comes with both power AND restrictions on the use of that power. For these Leftists, all power that an individuals finds themselves with is to be used to advance leftwing political goals. They would consider not doing so to be immoral.

    It's a self-destructive, short-sided morality. By abusing the powers of a profession, they destroy the trust of that profession. Just look how far judges and academics have fallen in the public eyes in the last 40 years. People used to view them as objective and trusted the institutions they ran. Now, they don't. The moral authority of the courts and universities is almost entirely gone.

    The medical profession will quickly follow if doctors don't stamp out the progressive (no pun intended) politicization of medicine.

  6. "they almost certainly will be stunned into indignant incoherence if they end up actually receiving the full punishments their actions allow."

    Let me fix that

    they almost certainly will sue if they end up actually receiving the full punishments their actions warrant."