Stand Up or Stand Down

American Medicine rose from the shadows of Western European medicine in the last quarter of the nineteenth century and in the early 20^th century. Great men and women founded great institutions. Most of those men and women were devout in their religious convictions and in their devotion to first their “calling” and secondly to their patients. As an example, I was always humbled by the story of the Catholic sisters that founded St. Alphonsus Hospital in Boise. St. Al’s was opened and then run by five Sisters of The Holy Cross in 1894.

Across our country, thousands of hospitals were opened and run by Protestant, Catholic, and Jewish religious communities. Service before self and the covenant relationship between provider-patient and God provided the moral predicate for the care given to all patients, and served as the hope that was the promise of medical scientific investigation and medical education that made American Medicine the envy of all the world. The “trust dividend” that had been earned by generations of doctors and nurses has been severely eroded by a command-and-control model that lacks a moral predicate and places the patient in a position of “customer” or “client”. I shudder to think what The Holy Cross Sisters, The Mayo Brothers and Sister Mary Joseph, or The Founding Fathers of The John’s Hopkins would think of our now almost completely Federalized Health Care system.

In my most humble opinion, the blame for the demise of trust and the quality of care over the past ten years in medicine is almost solely the fault of those doctors and nurses who have been complicit in the corporatization of the health care delivery system. Call it vertical or horizontal integration, call it a realignment of a division of labor, or consolidation of supply chains, or call it for what it is, a gravy train of government reimbursements that redistributes revenues not into the hands of patients or their caregivers, but into the hands of administrators and government regulators. I wonder what Sister Patricia Mulvaney would think of a hospital administrator making $18.2million/2yrs—or Gil Gilbertson for that matter—all former CEOs at Al’ and Luke’s.

Think about the Covid response both at the National Level and in our own State. Physicians or public health specialists would get on TV and advise patients how to mitigate against their Covid risk. The doctor-patient relationship was severely and negatively impacted by the government and media’s insertion into the dynamic.

Would you hire the CEO of a Fortune 500 commercial plumbing company to fix your busted toilet in your home, or would you call your local plumber that may have installed the plumbing in the house to do the job? Dr. Fauci hadn’t taken care of patients and families at the bedside for years, same with several of the experts who were advising us in Idaho. Why listen to them and not your doctor or your nurse at the bedside who knows you far better? Would you trust Dr, Fauci more than your own doctor—or plumber for that matter?

The other problem is that the medical societies and professional organizations and academicians practicing at places like Mayo and Johns’ Hopkins, and St. Luke’s/Al’s have created a narrative that claims to be scientific, but common sense and reason tell us that is political. Like an echo chamber politicians quote “expert sources” and try to create or adjudicate laws that are ungrounded in any sort of not only “science” but also lack any moral or ethical predicate. Two cases will prove my point.

In the July 6^th Wall Street Journal Ted Frank points out in an article entitled JUDGE JACKSON’S INCREDIBLE STATISTIC that in her dissenting opinion the good Judge purported the benefits of diversity in medicine because high-risk Black newborns had better outcomes—she said it “more than doubled the likelihood that the baby will live” when they had Black Obstetricians attending to mother and child. The claim was preposterous, but the brief sites in a footnote the same claim by The Association of American Medical Colleges. Mr. Frank traces the claim by following the footnotes that sited a 2020 article from a business professor at George Mason University that made no such claim! The article showed that from 1992 until 2015 that there was a 0.13-0.2%improvement—not statistically significant, for Black babies attended to by black pediatricians—not obstetricians. The study also used the wrong statistical tool for evaluating the results—linear regression that should be used to evaluate a normal distribution of variables instead of a more appropriate logistical model that again showed a statistically insignificant improvement in mortalities. Using the logistical model, it also showed that Black doctors had a higher mortality rate for white newborns and a higher mortality rate overall. But that all doesn’t fit the political narrative. All differences were statistically insignificant and prove that in our country good doctors, no matter their race, take good care of patients regardless of their race.

The second very troubling issue that has been the overly politicized is the transgender issue. The American Academy of Pediatrics complicity in advocating for hormonal and surgical treatments designed to obstruct normal development (arrest puberty) and surgically change a phenotype and secondary sex development, has approbated, and coopted a history of rules of informed consent that predate the Geneva Convention, and that has subjugated all rules of morality upon which medical ethics have been traditionally grounded dating back to the Hippocratic Oath—”First do no harm”. Most practicing physicians agree with me, but they are afraid to stand up for their patients. Most are today employed by large hospital systems, and they are afraid to speak up for fear of retaliation from their employers. The “covenant relationship” between patient—doctor and nurse, has been reduced to less than a fiduciary relationship where the wellbeing of one’s family—a job for a provider, is the primary concern. Patients are a means to a financial end—not the end itself.

It is time for those in the Medical and Nursing professions to stand up or stand down. Your patients need you.