The power of professionalism: should it be used as a political weapon?

Physician Executive, Jan-Feb, 2007 by Richard E. Thompson

How many doctors does it take to change a light bulb?

Only one.

The doctor stands on a ladder and holds the bulb while the whole world revolves around him.

One reason doctors think we are gods is that some people treat us like gods. Like ministers, priests, rabbis, and professors, we have the power of professionalism. Parents of babies I cared for in my neonatologist years would jump in the nearest river if I asked them to.

Well, not literally, but you get the point. When a physician uses the power of professionalism as a political lobbying tool, is it ethical behavior or exploitation?

Emily Brooker graduated from Missouri State University in May, 2006. Now she is suing MSU, claiming that her First Amendment rights were violated in a university class.

Allegedly, one of Brooker's professors required each student to participate in a class project by signing a letter, written on MSU letterhead and to be sent to the Missouri state legislature. The letter endorsed adoption of children by gay couples.

Booker refused to sign the letter. According to the lawsuit, her professor claimed that refusal to participate in this prescribed manner violated the School of Social Works' "Standards of Essential Functioning in Social Work Education."

University president Michael Knietzel promised the press that MSU would promptly investigate the matter. (1) A few days later MSU settled the suit.

Brooker received $9,000 cash plus tuition and fees toward a Master's degree at any Missouri university, and expungement from her record of a university ethics committee's review of the matter. The professor will be allowed to keep his position on the university faculty.

What is politics?

Like ethics, politics is a clumsy word because it is singular but ends in "s." Also like ethics, politics means different things to different people. Some think of politics as synonymous with electioneering. It is not.

The political process is the art and science of guiding, influencing, and implementing government policies at the federal, state and local level.

The electioneering process is a periodic opportunity for citizens to elect government leaders whose policy beliefs best reflect the will of the voting majority.

Ask an executive, "Are you active in politics?" The response will likely be that look; the one that says, "Well, duh, did you just fall off a turnip truck?"

Activity in the political process, such as influencing state regulations governing hospitals, is part of an executive's job description.

Now ask a doctor, "Are you active in politics?" The reaction may be a quick and absolute denial. "No way, and I never will be."

Yet you happen to know that the doctor contributes to candidates' election campaigns and that he often attempts to persuade people to think his way about a political issue.

Is the doctor lying? Chances are that he is not. The physician may equate "active in politics" with "run for public office." Articles on doctors in politics sometimes inadvertently contribute to that extremely narrow view. (2)

Lobbying and lobbyists

Like every other citizen, a physician is often an amateur lobbyist.

Any effort to persuade elected representatives to pass or defeat a legislative proposal is participating in the political process. Such an effort is called lobbying.

With persuasive arguments, lobbyists would pitch representatives to vote for the interests of the business or activist group paying the lobbyist. Today, lobbying has a bad name. Not infrequently, lobbyists eschew persuasive argumentation in favor of simply "hiring" a few legislators. If not the norm, this practice is too widespread to be acceptable in a country that claims to be on the moral high ground.

Make no mistake about it; unethical practices by some lobbyists do not negate the importance of lobbying. And amateur, grassroots lobbying efforts and letters to the editor are as important as more sophisticated efforts of professional lobbyists.

Should physicians participate in this process? Of course. It's a free country.

However, because of the power of professionalism, there is arguably a legitimate double standard. To avoid betraying the trust of patients and fellow citizens, and also to avoid sullying the medical profession's reputation for ethical and moral behavior, a physician must be especially careful not to exploit the power of professionalism.

A physician's participation in the political process and/or in electioneering is arguably ethical rather than exploitative if six criteria are met:

1. The doctor's interest in the issue is part of his or her professional ethic.

The doctor asks patients to write Congress urging tight emission standards for auto manufacturers, in the interest of clean air which is a public health concern.

2. The doctor has no conflict of interest.

The doctor will not benefit economically if his candidate or his political position prevails.

3. The doctor does not play the quality card, or use any other technique to play on people's fears.