Contrasting the AAMC Endorsement of Tom Price with Jordan Cohen’s Support of Humanism and Professionalism.

Posted on | January 27, 2017 | 4 Comments

Mike Magee

The decision by the AAMC to aggressively endorse Tom Price’s candidacy for HHS Secretary has confused and concerned more than a few of my academic colleagues. In light of the organization’s work on reinforcing social consciousness and empathy in medical students, it struck a remarkably discordant note.

In 2002, I approached the AAMC with an idea. What if they were to empower their Organization of Student Representatives (OSR), a body made up of one elected student from each of the MD granting Medical Schools, to select each year the single physician nationwide who best embodied the doctor these medical students hoped to become? “Real doctors. Real Teachers. Real Heart.”

With the support of then CEO Jordan Cohen, we explored a list of seminal values the awardee would possess, and settled on five:

1. Patient-Centered: A personal commitment to a patient-centered, pride-filled approaches to the organization and delivery of health care.

2. Professional Collaboration: Promotes collaborative processes across all disciplines.

3. Community Service and Leadership: A community servant who believes in equal access to information and health care for all.

4. Continuous improvement: Recognizes personal imperfections and seeks scientific and humanistic solutions that ensure positive and coordinated outcomes.

5. Professional Positivity: Commitment to personal revitalization, recognizing the responsibility to provide hope and reassurance to all we serve, and to promote courage, strength and positive attitudes.

The program was called the “Humanism in Medicine Award”. It was a great success as measured by the number of participating medical schools, the integrity of the student-led selection process, and (most of all) the quality of the awardees.

More than a decade after my departure from the scene, the program survives under a new title, the Arnold P. Gold Humanism in Medicine Award which “annually honors a medical school faculty physician who exemplifies the qualities of a caring and compassionate mentor in the teaching and advising of medical students.”

I was reminded of this program last week while reviewing a special JAMA issue from 2015 dedicated to “Professionalism in Medicine”. I reread all of the articles, including one from my old friend, Jordan Cohen, now Emeritus at the AAMC. His article was titled “Tasking the ‘Self’ in the Self-governance of Medicine”. It explored the rights and responsibilities of physicians in a modern society.

When we juxtapose Dr. Cohen’s words with those in a recent NEJM article evaluating the legislative record of Rep. Tom Price, we see stark contrasts. The NEJM piece, written by two HHS directors, says: “Price’s record demonstrates less concern for the sick, the poor, and the health of the public and much greater concern for the economic well-being of their physician caregivers.”

Jordan’s view: “Medicine’s social contract with society is the implicit, mutual understanding of the obligations physicians individually and collectively agree to on the one hand, and the privileges they are accorded by the public in return on the other hand. ‘Society grants physicians status, respect, autonomy in practice, the privilege of self-regulation, and financial rewards on the expectation that physicians would be competent, altruistic, moral, and would address the health care needs of individual patients and society’¹… medicine in the United States enjoys an astonishing degree of autonomy. However, this skew also saddles medicine with an enormous degree of vulnerability for unwelcome constraints on that autonomy.”

He furthur cautions: “The hallmark of medical professionalism is a subordination of self-interest to the best interest of patients and the public.⁸ Maintaining that commitment to professionalism in the face of the many temptations afforded by today’s commercialized and overstressed health care system is, to be sure, no easy task. There are so many opportunities to give in to greed, to be arrogant, to abuse the power gradient inherent in the patient-physician relationship, to exploit conflicts of interest, to fail in the duty to be conscientiousness. But succumbing to temptations such as these, and abandoning the commitment to professionalism, is tantamount to physicians’ forfeiting the right to self-regulation.”

On “humanism”: “…humanism denotes an intrinsic set of deep-seated convictions about one’s obligations toward others.⁹ It is the passion that animates true professionalism. It is the passion that motivates many, if not most, young people when they choose a career in medicine. It is the passion that is all too often dampened by the rigors of medical education and by the hassles of medical practice. But it is the passion that must be nurtured, reinforced…”

And finally, on public trust: “No matter how effective professional organizations are in the pursuit of self-regulation, sustaining public trust in the profession is ultimately the responsibility of individual physicians being faithful to their obligation as professionals and being earnest in upholding the interest of their patients and the public…Trust in physicians is the foundation upon which the social contract with society rests. But trust in physicians is not a birthright. Trust is earned, not owed. The only way physicians can earn trust is by being trustworthy as true professionals.”

By endorsing Tom Price, the AAMC has granted him a “dehumanizing award”. The organization is much better than that.

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