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

The 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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