A little lip from an LIP

A message to all physicians from the chair of the AMA Board of Trustees, William G. Plested III, MD.

By William G. Plested III, MDis a thoracic and cardiovascular surgeon from Brentwood, Calif. He served as AMA board chair during 2003-04, and as AMA president during 2006-07. Posted June 7, 2004.

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For too many years I have been obliged to live with the insult of being referred to as a "provider." The good news is that one of my favorite organizations to bash -- JCAHO, the Joint Commission on Accreditation of Healthcare Organizations -- finally committed to getting rid of this appellation.

The bad news is that JCAHO is now on a crusade to change our names to "licensed independent practitioners" or "LIPs."

I think that I made the mistake of saying something nice about JCAHO in the past year, and this is what I get in return! I promise to do better in the future.

I long for the day when I will be recognized by JCAHO and others simply as a physician, a title that I have earned with thousands upon thousands of hours of conscientious study, practice and commitment. However, I suspect I hope in vain.

In this era of political correctness, we are witnessing social promotion in our public schools, massive grade inflation in our most prominent universities, and sporting events during which no one keeps score.

This last is to avoid embarrassing the losers (which, of course, only works if our public school system ensures that kids cannot keep two simple numbers in their heads for the short duration of a game and also have no will to win).

We are also inundated with the wholesale renaming of jobs to inflate the importance of job holders, obliteration of differences in training by using widely inclusive titles, and the substitution of government or other bureaucratic fiat for education and experience.

For example, last month the Oklahoma Legislature passed a bill that had a last-minute amendment by insertion. HB 2321 was originally "An Act Relating to the Oklahoma Pharmacy Act." The amendment includes the following sentence: "The practice of optometry is further defined to be non-laser surgical procedures as authorized by the Oklahoma Board of Optometry, pursuant to rules promulgated under the Administrative Procedures Act."

In plain English, Oklahoma optometrists now can perform non-laser surgical procedures on our patients. The scope of these procedures will be defined by the Oklahoma Board of Optometry. No licensed surgeon or surgery-accrediting board will have any say regarding the qualifications required to perform these procedures.

So much for medical school, residency, fellowships, etc. It would appear that the word "physician" is just a name, and that it would be selfish to deny to others the privileges of physicians -- or would it be? Is it possible that strict adherence to the privileges, qualifications and ethics demanded of physicians actually protect the public? We at the AMA would have to say, "Yes!"

No doubt there are individuals who feel that this issue is really not very important, and that we should be magnanimous and embrace everyone who wants to join us. I would submit that such an approach will lead to the very destruction of our profession.

If physicians feel that the privileges we have so dearly earned should be available to all for the asking, I can guarantee that there will be no profession left. History is replete with examples of the lesson that there comes a time when one must fight for those ideals and principles that he or she holds dear, or they will be lost.

I can assure you that the title "physician" is dear to me, and I rejoice that so many colleagues share my respect and love for our profession and for all that the word "physician" represents.

I also respect others in all walks of life; however, this respect does not extend to diminishing my own accomplishments or profession in a misguided attempt at inclusiveness.

So in response to JCAHO's latest insult to my integrity and the integrity of my profession, my answer is a resounding, "Thanks, but no thanks."

For those in JCAHO who have no respect for the title "physician" and all that it connotes, I personally respect your right to your beliefs.

When your spouse, parent, child or loved one is critically injured or ill, I will fight for your right to have an LIP available, since to suggest that you might want a physician would prove semantic discrimination on your part. Of course, such discrimination is something to which you would never ascribe.

As for physicians, I hope that we will continue to fight to protect the rights and privileges of our profession, rights that we have earned through years of education, training and service.

And when our loved ones -- or our patients -- are critically injured or ill, we will demand -- and get -- a physician. Not a provider or an LIP. But a licensed, practicing physician.

Because we, of all people, understand the difference.

William G. Plested III, MD is a thoracic and cardiovascular surgeon from Brentwood, Calif. He served as AMA board chair during 2003-04, and as AMA president during 2006-07.

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