Ex-Surgeon General , Richard Carmona, MD, has testified that the president’s administration had muzzled him on a number of healthcare topics because he alleges topics that didn’t fit in ideologically, theologically, or politically, were “often ignored, marginalized, or simply buried.” The current Surgeon General nominee, James Holsinger, Jr., MD is being grilled over if he’s tough enough to stand by his medical convictions, and resign if the administration turns a deaf ear, and also if he’s “anti-gay.”
First the “anti-gay” stuff. As physicians, we should all be gender, gender preference, color, religion, and even in the case of warfare, combatant side blind. A patient is a patient. We do this because it is how we are trained and how we are expected to care for patients. Is it OK to have a personal opinion about gender preference, race, religion, or conflict combattants? Absolutely. Is there any reason personal opinion should affect our care of patients. Absolutely not. Give the man a break. If he wants to think homosexual sex is unnatural and unhealthy, so what? I think it’s unnatural and unhealthy to inhale the smoke of burning tobacco. And, as a General Surgeon (not to be confused with a Surgeon General), I tell my patients not to smoke. And when they ignore my advice, I still take care of the smokers because IT’S MY JOB. As long as a Surgeon General works to fight diseases of all patients, so what? If he were to treat a gay man or woman, and told the individual he “disapproved,” but still took care of the patient to the best of his abilities, and the patient trusted his care, personal opinion doesn’t really enter into the treatment.
But political pressure. That’s a deeper issue. That’s really about trust. Physicians must treat patients to the best of their ability. That’s part of the oath. And if you’re Surgeon General, your obligation is to “treat” all your “patients” in the U.S. to the best of your ability. You tell your “patients” what you feel is the best decision, from a SCIENTIFIC basis, what they should do. If the patient refuses to listen, that’s their business.
I have explained the use of blood transfusions to patients who were Jehovah Witnesses and they have refused transfusions. I can disagree with their decision, personally, but I still take care of them and respect their wishes by not giving them blood.
But the choice is with THE PATIENT. Not the government. Not the President. Not the Congress. Not the Judiciary. Otherwise, patients will stop trusting their doctors.
By the nature of the politically appointed Surgeon General position it follows this is a POLITICAL JOB. Now personally, I think it’s monumentally stupid to allow ONE doctor be the political voice of medicine and healthcare. When there are tough clinical decisions to make with a patient, we get consultations. Often, consultations differ and the ultimate choice is made by…. guess who? THE PATIENT. If a group of physicians of varying specialities come to a consensus, well, that’s pretty impressive and generally a correct decision based on information available here and now.
My idea of what the “surgeon general” should be is a panel of well educated physicians representing various specialties where decisions are weighed in as a consensus, rather than a single vote. Kind of like the Supreme C0urt, but with white coats rather than black robes. Sure, you can have a Chief Surgeon General, but the dissenting votes from the Surgeon Lieutenants should be made publicly so patients can hear the different opinions. And then LET THE PATIENTS decide!
When I’ve been with a group of physicians who are debating the best course of action for a patient to ultimately chose, I’ve never had a hospital administrator, (or political administration), have a vote in the decision making. If you can’t trust your physician to tell you the facts as he/she know them, and LET THE PATIENT ULTIMATELY DECIDE, it’s a crock.
This brings a larger question to mind. If Medicare is a GOVERNMENTAL HEALTHCARE SYSTEM, and the “government” is weighing in on healthcare decisions from political, theological, or ideological perspective, rather than a medical perspective, how is this to work to the patient’s benefit?
We have a doctrine of separation of church from state. We should also have a doctrine of separation of healthcare from state. If we can’t count on an administration to look at the science of healthcare and to “muzzle” a Surgeon General, how can we trust Medicare? UN-MUZZLE the Surgeon General. Let’s hear from him/her on a regular basis what recommendations are given to the administration. Because then at least patients will know what the REAL DOCTOR is thinking, and not the government. Because in healthcare, it’s all about the PATIENT.
Or give the patients the right to sue. That’s right. If a government withholds prudent treatment to a patient because it “disagrees” from a political, idealogical, or theological basis, AND it HARMS the patient because they failed to inform the patient of other options, let ‘em sue the government for malpractice. Or for treating a patient without a medical license.
You know, that would be one way to curb medical malpractice lawsuits, wouldn’t it?
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