TO THE AMA: IT'S NOT ABOUT YOU.

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The most famous medical painting in the world is probably Sir Luke Fildes' THE DOCTOR. Fildes was inspired by the physician who attended his first born son,  Philip, who, despite the doctor's efforts, died on Christmas Eve, 1877.  When Fildes was later commissioned to produce a new work, he chose to portray "the doctor in our time." 
The_Doctor_Luke_Fildes.jpg


THE DOCTOR captured the public imagination. Volumes have been written on what the painting means. To Fildes it was about hope: the light coming through the window was for him the hope that comes with dawn.  To others the painting suggested that "character and virtue are as important as knowledge and skills."
 
I've always felt that the painting is not about the doctor. Instead, I think we viewers identify with the child; we see ourselves as the patient and when we do, this is the kind of attentive, dedicated physician we want caring for us.  Indeed, the painting recalls for me the Biblical line:  "I was ill and you cared for me,"  a line that is soon followed by "Whatsoever you do to the least of these, my brothers and sisters, you do unto me."
 
Which brings us to the American Medical Association: when President Truman in 1949 put forward a proposal for nationalized medical care, the AMA marshaled its forces to run a brilliant campaign revolving around Fildes'  THE DOCTOR.  They used the image in posters and brochures along with the slogan, "Keep Politics Out of this Picture."   They hoped to suggest that Truman's plan would ensure that a sick child like this would never get a home visit or good care.  65,000 posters of The Doctor  were displayed. It worked. The AMA 'won' by generating a public skepticism which even now poisons the debate on health reform.

Fast forward to 2009. From their recent pronouncements, it sounds as though the AMA is back at it again. They've said that health services should be "provided through private markets, as they are currently."  (Wonderful! We know how well that works.) They've also said, "The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans."

No doubt the AMA is gearing up to use its war chest and its lobbyists to fight health care reform; let's face it, they're worried that changes might hurt physicians' income, and that is understandable. But please don't tell the American public (a public already disenchanted with physicians and health care) that you are doing this for their benefit because of your great concern for the patient. The public does not believe you. They aren't that naive.

The bottom line: health care reform is about the patient, not about the physician. 

To the AMA: please study Fildes' painting. It's not about you.


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(For the reader who wants to read more please go to my favorite medical blog, KevinMD.com for an excellent discussion on these issues.)



 


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Abraham Verghese is an author, physician and med school professor. He is the author of Cutting for Stone and his writing has appeared in many major publications. More

Abraham Verghese is a physician and writer. His third book and first novel, Cutting for Stone, was published by Knopf in 2009. He is also known for two acclaimed non-fiction works, My Own Country, which was based on his experiences working with persons living with HIV in Johnson City, Tennessee; that book was a finalist for the National Book Critics Circle award and was made into a movie. He followed that with The Tennis Partner, also a New York Times notable book and a national bestseller. His writing has appeared in The Atlantic, The New Yorker, The New York Times , The New York Times Magazine, Sports Illustrated, and The Wall Street Journal as well as many medical journals. Verghese is board-certified in internal medicine, pulmonary medicine and infectious diseases. He attended the Iowa Writers Workshop at the University of Iowa where he earned his MFA. He currently practices and teaches at Stanford University School of Medicine where he is a tenured Professor and Senior Associate Chair for the Theory and Practice of Medicine in the Department of Internal Medicine.
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