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Annual Session News

The following article originally appeared in Annual Session News, the official Annual Session newspaper of the American College of Physicians-American Society of Internal Medicine.

Keynote: change in medicine since Sept. 11

By Phyllis Maguire

According to Walter J. McDonald, FACP, most of the events that radically change the course of medicine produce their effects only over time.

"Think of transplant technology or the evolution of cardiac surgery," Dr. McDonald said in a recent interview. "While the impact of those developments was dramatic, it was gradual and became apparent only over the long haul."

That's why the Sept. 11 attacks, which affected the medical profession immediately and profoundly, have functioned as such an eye-opening experience for medicine, said Dr. McDonald, the College's Executive Vice President and Chief Executive Officer. During his keynote speech at this morning's Opening Ceremony, he will explore how the profession has refocused itself since the Sept. 11 terrorist attacks.

"Many things were altered by the attacks," Dr. McDonald explained recently, "but I thought from the beginning that medicine might be the most radically affected. We were called upon to do things we never had to do before."

Almost immediately, he said, physicians had to recognize and treat unfamiliar bioterrorism agents while keeping patients calm and informed. They had to help revive a withered public health system and prepare their communities for the unthinkable possibility of mass casualties.

Physicians were forced to cope with patients thrown out of work and off insurance rolls, patients who might have to go without needed medications or put off treatments they could no longer afford. And they saw government resources that seemed primed to fund some of medicine's most coveted goals evaporate.

"Almost overnight," Dr. McDonald said, "we went from having enough money to achieve objectives we'd pushed for years—like universal coverage, a patients' bill of rights and prescription drug benefits—to a situation where we might not be able to pay for projects already underway."

But even as the profession struggled to face challenges that continued to mount after Sept. 11, there was good news. Dr. McDonald said physicians by and large relied on the principles of professionalism to meet those challenges.

"I realized that even though circumstances had changed dramatically, the same principles we've always practiced still apply," he said. "The principles don't change, they just have to be refocused on our profession's new realities."

As an example, Dr. McDonald referred to the Medical Professionalism Project, launched by the ACP-ASIM Foundation in conjunction with the American Board of Internal Medicine Foundation and the European Federation of Internal Medicine.

The charter that came out of that project defines professionalism as the principles individuals in a profession use to fulfill their contract with society. (The College's Board of Regents endorsed the charter last year.) Dr. McDonald said that the profession used many of the principles mentioned in the charter to guide their response to the terrorist attacks.

Physicians' commitment to professional competence, for example, was readily apparent in their response to bioterrorism, as was their commitment to educating patients. Physicians immediately got themselves up to speed on bioterrorism agents, and they used the media and the Internet to get information to patients. In fact, Dr. McDonald said, the attacks proved that medical professionals should be the primary source of health care information, as lay authorities broadcast confusing and inaccurate messages.

The commitment to improving access to care and a just distribution of resources is now a major focus of the profession. In part, this new commitment is being driven by a floundering economy where more patients face financial hardships and a lack of health care coverage.

While government funds to help the uninsured have shrunk, Dr. McDonald said that the profession's responsibility to improve access is leading physicians to even stronger advocacy for needed reforms like drug benefits.

Changing budget realities also mean that while physicians won't abandon principles of professionalism, Dr. McDonald noted, they must modify their approach.

"We have to continue agitating for universal coverage, but we won't be able to get there in one fell swoop," he said. Instead, the College continues to support steps toward more comprehensive coverage, including a seven-year plan for achieving affordable coverage that the Board of Regents approved earlier this week.

At the core of medical professionalism, Dr. McDonald continued, are three principles affirming the primacy of patient welfare, the importance of patient autonomy and the need for social justice. These principles will continue to provide guidance that will permit medicine to play a key role in the post-Sept. 11 world.

As American physicians consider the conditions that give rise to terrorism, several constants emerge: poverty, the lack of education and the inequitable distribution of health care resources.

"The just delivery of health care services around the world might possibly become a key element of our foreign policy," Dr. McDonald said. "This could be the Marshall Plan the world needs in the wake of Sept. 11. It would address health care disparities that the medical profession is already beginning to target."

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