Random Thoughts from a Restless Mind

Alex, the question is: What is the one thing that ASCRS, the American Society of Cataract and Refractive Surgery, can do for its members that it isn’t already doing?

ASCRS, AAO (American Academy of Ophthalmology), AMA (American Medical Association), and the various and sundry other organizations of letters are all of the same ilk. Each one was founded with the idea that physicians as a general group, and more tightly defined specialist groups, needed some sort of representation. Some sort of trade group that would present our needs and desires to other groups like the government, insurance companies, and the public. You know, someone to take OUR side in a discussion, to support US in a debate.

So, how’s that working out for you, Doctor? How well are your trade organizations doing, you know, carrying the flag, supporting you and your issues, the things that matter to you? Like protecting your relationship with your patients? Protecting you from frivolous lawsuits and the incessant threats that make you add “cover my ass” to every treatment plan? How are they doing taking up the cause of preventing yet another government program from gumming up your day with more useless, purposeless paperwork? How’s all of that going?

Yeah…thought so.

Once upon a time organizations like the AMA stood for something. The AMA in particular was the ethics referee for all physicians, as powerful as a FIFA ref in the World Cup, and frankly just as impervious to outside influences and criticism. To be censured by the AMA was a serious thing, the only thing worse being the loss of your license to practice medicine. Now? Do you remember reading the histories of the eunuchs who waited on the Chinese emperors of antiquity, emasculated and with a veneer of power that they brandished with a flourish. They lived for the intrigue; they thrived on the daily ebb and flow of palace life, content to be AROUND the tables of power, though they were not really AT the table. It’s like that now.

When did it happen? When did this group of “all-powerful” become a collection of empty sacks? It probably started whenever the AMA lost its great battle over its prohibition of advertising, a case of free speech and restraint of trade in which the AMA was thrashed. It’s never been the same since then, just one small defeat after another. Indeed, the very nature of the game was changed at some point, whether it was the advertising defeat or some other tipping point.

I’ve looked very hard, called into play my most powerful google-fu, looking for the answer. Who led us to this point? Could it really have been a Dr. Chamberlin? No…to0 easy…can’t be. It would be just too perfect if the 3+ decades of universal appeasement as the modus operandi for all of the medical alphabet organizations could have been started by someone so named. Nevertheless, appeasement is precisely what organized medicine has all been about for decades.

Surely, if we agree to accept Medicare payment as our payment in full, they will trust us to do what is right for our patients. If we just agree to label our charts with these treatment and billing codes they will assume that we are doing what we say we are doing. Hey, they’re going to pay you a BONUS for faxing your prescriptions with a computer system. Well, you know, a computerized medical record is theoretically best for our tapped out payment system, and if we do everything just like they say there’s a possibility that they might pay a little bit so you’ll lose less money on it. Well, you know, there are some docs who have cheated the system, so we’ll have to accept the “guilty until we can’t find any way to not find you innocent” policy of regulatory enforcement.

Drip…drip…drip…the slow torture of seeing the next drop come…drip…each tiny capitulation labelled as “cooperation for the common good”…drip…the willful, purposeful blindness of the appeasers…drip…well, certainly THIS time they will reward us for being good team players…drip…no lesson ever learned…DRIP.

Well, Dr. Chamberlin, here’s what I’ve learned. It doesn’t work, this appeasement thing. It never does. It’s never enough, all that you’ve given up, all the times you’ve decided that we would “take one for the team.” Appeasement never works because those you wish to appease do not respect you, and because of that they do not respect US, the physicians. Indeed, they view us with barely concealed scorn. It doesn’t matter whether they are Republicans or Democrats, government or private, Aetna or the Blues, they know that you don’t have what it takes to ever take a stand. You don’t know what it is to use leverage, wouldn’t recognize it in your pocket, and would turn away from it if you did.

What to do…what to do? Believe it or not there are still some physicians out there who have neither emptied their (figurative) sacks, nor become so jaded and angry that they can no longer muster the empathy necessary to be a doctor. What should we do? Should we retreat to some nirvana, some mythical place like the mountain hideaway built by John Galt to house those who would traffic in excellence in a world where success is born of merit? Ah, would that we could. The closest that any might come to this is to retire, withdraw their services from the system and become conductors. Or provide their services to all comers for free; that would shake things up. Not many of us can afford to do that, and if we could not many of us are willing to walk away from that which has defined our very beings for so long.

So, what? Well, for me, I have gazed too long on a system built on the cynical abuse heaped on the followers of the appeasers to avoid becoming just a little bit cynical myself. It’s a game, you know? Games have rules and regulations, little battles that can be won even though the war might already be lost. Perhaps an extra patient at the end of the day. A perfect chart with every preferred practice pattern item covered. Who knows? The rules ebb and flow as the alphabet organizations push a little, pull a little. There’s always a game, a little battle, rules to play by, rules to follow, a way to win within the rules today. A cynical approach to a cynical battle, with hopes for no collateral damage. 10 years of that kind of today, and then…

Alex, the answer, apparently, is nothing, because that would be better than what they are doing now.