ACP: Doctors as leaders – the value of civility

A guest column by the American College of Physicians, exclusive to

by John Tooker, MD, MBA, MACP

ACP: Doctors as leaders – the value of civilityThe campaigning for the mid-term elections reminds us once again of the state of civility – or lack of civility – in American politics. By civility, I mean showing regard for others. We are beset by campaign attack ads that are often factually wrong and designed to diminish an opponent by innuendo rather than constructively informing the electorate about the issues and the positions taken by the candidates on them.

Physicians have policy and political roles too. We have a professional obligation to responsibly engage in debate on behalf of our patients and profession. From the Ethics Manual of the American College of Physicians, 5th Ed.:

“Physicians should help the community and policymakers recognize and address the social and environmental causes of disease, including human rights concerns, poverty, and violence. They should work toward ensuring access to health care for all persons; act to eliminate discrimination in health care; and help correct deficiencies in the availability, accessibility, and quality of health services, including mental health services, in the community.”

These very patient care issues – access, discrimination and quality of care – were front and center in the recent national health care reform debate, to the credit of the physicians that fully engaged in the debate, whether one agrees with the final Affordable Care Act legislation or not. Unfortunately, during the political conversation within our profession, there were also instances of incivility– remarks and statements made by physicians that went beyond the bounds of decency, and at times were perceived as threatening by the recipients of the comments.  Instant and reflex electronic communication facilitated such comments – hitting send before thinking twice or thrice – and the opportunity for civil discourse was lost. Physicians have a dual obligation as citizens and as members of a learned profession to be responsible in their actions. The ACP Ethics Manual is clear: “Physicians’ conduct as professionals and as individuals should merit the respect of the community”. The Charter on Medical Professionalism developed by the Foundations of the American College of Physicians and American Board of Internal Medicine, and the European Federation of Internal Medicine (2002) makes the same general point.

Policy makers and politicians are looking to physicians to provide leadership at every level. Because of the standing based on moral principles and education that physicians have within our society, there are and always have been great leadership opportunities to improve the care of our patients and the satisfaction of our profession. If we don’t act professionally, we diminish our standing and ability to lead.

Any success going forward in critical areas such as delivery and payment reform will continue to require leadership to bring together the varying views within medicine, and with other key stakeholders such as consumers, employers, state and federal government, and health plans. Whether leadership is exercised at the local, regional or national level, the ingredients for success are the same, including civility. There is a small but revealing book, Rules of Civility, by Richard Brookhiser, that describes the moral code that guided George Washington as the first president of our republic during very difficult times. The first rule is: “Every action done in company ought to be done with some sign of respect to those that are present.”

John Tooker is Associate Executive Vice President of the American College of Physicians. His statements do not necessarily reflect official policies of ACP.

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  • ninguem

    Can someone tell me of a time when American politics was civil? Australia? Things are real pleasant in France right now. I’ve always liked this scene from “The Americanization of Emily”
    Puts it in context.

    Or the fistfights and wrestling contests you get in the Taiwan and South Korean legislatures.

    Though I certainly accept political civility as an ideal.

  • John Ryan

    I certainly agree that threats have no place in any discussion, among physicians or others. However, there is substantial disagreement, from many doctors and most of the public, on the merits of the direction taken with the present health reform law. As an organization, ACP has supported that law, and has been non-responsive to any opposing view, even to the point of publishing an article by White House insiders predicting the demise of small practice physicians. This practice model, while considered by policy-makers inefficient, is the choice of most US patients, and it’s practitioners compose a large part of ACP, including the ACP President. And yet this article was presented without any critique or balanced editorial commentary. I read the emails sent to the Editor, very heated, but also totally to the point. The prospect of our own organization and its leadership abandoning us is very bitter.

  • Steven Reznick MD FACP

    I am one of those physicians who has been critical and uncivil in my communications with the ACP regarding health care reform and politics in general. I believe in our public and professional interactions with patients, colleagues and institutions for the practice of medicine and care of patients civility is appropriate.
    Politics is a dirty business. When you roll in the mud you have to expect to get dirty. Politics is influenced by dirty money, back room deals, lobbyists lavishing legislators and their aides with junkets, dinners and favors in exchange for their support and vote. This is the way business does politics.
    As physicians we are asked by the ACP to hide behind the white coat , and the hippocratic oath for the greater good of our patients while employers, insurers, pharmaceutical companies and politicians decide how health care will be practiced across this great country without significant physician input except for photo op purposes.
    As part of health care reform we asked for a revamping of the Sustainable Growth Rate physician payment law which has been ineffective since 1996. As part of health care reform we asked for meaningful tort reform and we received nothing ( an empty gesture of possible demonstration projects). As part of health care reform we asked for initiatives to re vitalize physician management of primary care services and we ended up with a plan predicated on the growth of scope of practices for nurses. We actually received an email blast from the ACP asking us to support the health care reform bill and call our legislators at the same time that the AMA advised us not to because the bill did not cover the key items of tort reform, Sustainable growth rate and scope of practice issues!!
    We pay extra dues to the ACP for their political action committees to represent us. Each time we hide behind the white coat and preach civility we end up with nothing . When another ACP official receives another honorary award for public service we will be stuck fighting pharmaceutical and insurance companies for permission to treat ,, prescribe and practice in a manner that represents what is best for our patients. If the ACP wishes to be in the political lobbying field it has to play the game the way it is successfully played!. When in Rome do as the Romans do.

  • Marc Gorayeb, MD

    That quote from the Ethics Manual (5th ed.) is an odd prescription for ethical practice. The statement lists moral, social and political imperatives that some reasonable, ethical physicians may disagree about. Physicians and non-physicians alike should all have concerns about human rights, poverty and violence. Those concerns can fairly be expressed through different philosophical, ideological and political points of view. The ethical practice of medicine is hardly predicated on them. 6th edition, anyone?

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