Thursday, May 05, 2005

Two 'Perspective' Pieces in NEJM for 05-05-05

With enormous pleasure I have just read the 05-05-05 number of the New England Journal of Medicine. The journal's innovations, including 'front-ending' the so-called 'Perspectives' writings, here clearly pay off.

It is surely no accident that Aneez Esmail's piece, 'Physician as serial killer,' on the UK's good Dr. Shipman--surreptitious killer of well over 200 elderly patients between 1970 and 1998--and Abraham Verghese's piece, 'The calling,' on the physician as reader, appear back to back.

The issue in both cases is our old bugabear of 'professionalism,' refracted through the classic dual prisms of regulation and the self made man. Nurture versus nature.

Verghese wins.

Esmail calls for more regulation--otherwise how to 'equalize the power imbalance'?--but doesn't really say how to make such a thing work. In these blogger pages we have seen just how well the watchdogs perform. Do cattle chutes make better cattle?

On the other hand, Verghese's essay is enormously winning and worth a read by anyone who wants to understand what true professionalism is all about. This, from the pen of a writer brave enough--huzzah!--to call the usual pabulum by what is really is.

'I have marveled,' notes Verghese, 'at the way in which selected fiction discussed in a medical school class effectively conveys the tenets of professionalism and multiculturalism without ever invoking those soporific words.'

Indeed, the whole push to codify, regulate, and legislate 'professionalism' strikes us as just another bloviation in the ongoing Pogo Revolution in healthcare. My recommendation: the astute Dr. Verghese, or someone like him, should be the next Flexner. The prognosis for this happening: well, what day is it today and how do you feel today?

1 comment:

james gaulte said...

Another great blog.Since I am new to hcrenewal,I am ignorant about what you mean by the "Pogo revolution" I am guessing it is " we have meet the enemy and they is us" but I don't know.