Jul 17, 2010

AMA: Emergency Medicine, Social Justice or Market Need?

In the span of one single blog post, Dr. Brian Zink, writing in the AMA Journal of Ethics, manages to directly contradict his primary thesis: Emergency medicine is founded on social justice and egalitarianism.

Normally, we wouldn't waste additional space in the blogosphere on obscure posts that only a handful of people will ever read; however, the insidious argument that Dr. Zink puts forth is firmly embedded in a much larger effort to promote a world-view that most would argue is incompatible with reality. Correction, a world-view that is incompatible with reality for those of us that pay our bills with money rather than theoretical constructs.

Sadly, posts like this one will likely be cited as evidence to support any number of political maneuvers, usually designed to promote additional regulations, oversight by more experts, and a general shift towards a more technocratic system. Thus, we are paying attention.

Dr. Zink opens with the argument, "unlike other fields of medicine, emergency medicine (EM) arose out of a progressive social demand for services that was tied to the moral and ethical aspects of providing care for poor and uninsured people."

Interesting premise. We're listening. Let's hear more...

He continues, "In July of 1961, James Mills Jr., MD, along with three fellow internists, gave up private medical practice and entered into a contract with Alexandria Hospital in Alexandria, Virginia, to provide ED coverage...Mills and his colleagues [also] found that they could make at least as much money in this new arrangement as in their private practices and actually work fewer hours per week ... At the same time, Mills was pursuing a humanitarian agenda."

So they started an ER service to quench their desire to meet a social demand and practice at a higher moral and ethical plane or they started an ER service to make at least as much money and work less?

It's amazing to see how these arguments continue to flourish, especially in the medical field. Apparently, the AMA opened the door when they began defining their professional ethic in terms of distributive justice ... in other words "to each according to his need" (page 10, slide 15) a quote made by a much more famous historical figure (see HERE).

If you care to read the rest of this article, it can be found HERE (although it's not highly recommended).