• Vascular Specialist Newspaper
• Volume 5 - 2009
• Number 9 online
• Number 8
• Number 7 online
• Number 6
• Number 5 Online
• Number 4 online
• Number 3
• Number 2
• Number 12 online
• Number 1
• Volume 4 - 2008
• Number 6
• Number 5
• Number 4
• Number 3
• Number 2
• Number 1
• Volume 3 - 2007
• Number 6
• Number 5
• Number 4
• Number 3
• Number 2
• Number 1
• Volume 2 - 2006
• Number 6
• Number 5
• Number 4
• Number 3
• Number 2
• Number 1
• Volume 1 - 2005
• Number 2
• Number 1

We live in interesting times. Our country is threatened by terrorism. We are embroiled in a difficult war. The world's stock markets and economies, including ours, are crashing. Many in Congress are self-serving and some are corrupt. Wall Street executives routinely act irresponsibly to fatten their paychecks at the expense of their stockholders and the public. Banks lent money for mortgages to borrowers who were at high risk for default and foreclosure. Both the borrowers and lenders should have known this. Living beyond one's means on borrowed money has been rampant in our society.

Movie stars and celebrities strongly advocate positions against our government and against our country's interests. Greed and self-interest seem to be the order of the day within our American society, and ethics, responsible behavior, and patriotism seem to be in short supply.

Being an "I-based" society rather than a "we-based" society has gotten us where we are.

Although this state of affairs is a problem for all U.S. citizens, it also has direct bearing on how vascular surgeons and other physicians should conduct themselves in these trying times. Let's look at some examples.

Vascular surgeons and other vascular specialists must always act in accord with what is best for the patient. Too often we succumb to the temptation of doing what is financially best for ourselves, our department, or our hospital, or what is best for our credentialing needs. An example of this is the widespread practice of placing carotid stents to treat marginal stenoses in asymptomatic patients. Ethics demand otherwise.

Similarly, institutions must resist the temptation to urge surgeons and proceduralists to increase their case loads to augment profit margins. Unnecessary cases will be done, patients' interests will not be served, and burgeoning health care costs will be further increased.

The same sort of greed prompts some health insurance companies and HMOs to deny coverage to patients for care that is justified and necessary simply so their CEOs can add bonuses to their million-dollar salaries. What increased value are all these extra dollars to insurance executives adding to the delivery of health care? Ethics demand that patient well-being replace greed as a primary motivation.

The U.S. tort system is a constitutional right designed to provide every injured party his day in court. That right should remain inalienable. But is the tort system the best means for policing doctors and the health care system to eliminate negligence and incompetence? I think not. The entire malpractice tort system is fueled by greed on the part of lawyers, expert physician witnesses, and opportunistic patients. This also adds to exploding health care costs. Advocates of the present flawed system claim it is justified because physicians are unable to regulate their own activities effectively and often cover up for their colleagues' blunders. This is often true, and I have personally witnessed several flagrant examples of such behavior. It must stop.

These are just some examples of irresponsible behavior promoted purely by self-interest and greed.

All must be reversed or the American medical system will collapse under its own economic weight. Our country simply cannot afford business as usual and still achieve the much-needed reform that must approach universal health care. Moreover, when one adds the greed-induced problems in health care to the greed-induced problems in our mortgage, banking, and financial systems, our whole American society and way of life are threatened with decline. Perhaps the same ethical deficiencies are major causes of the simultaneous crises in all three of these systems.

What can vascular surgeons and other physicians do to prevent these depressing possibilities? Clearly what is needed is a return to ethical, responsible, society-oriented behavior and a rejection of the greed-motivated and self-interested behavior that pervades American society. Destructive "I-based" values must be replaced by ethical, old-fashioned "we-based" values. Although such changes must occur throughout our society, it has to start somewhere. If vascular surgeons and other physicians lead the way, maybe the rest of our society will follow. This is a lot to ask from one segment of society. But if nobody starts this behavioral and ethical revolution, the alternatives are bleak. Why shouldn't we in the medical profession start the revolution?

There is one final key aspect of this ethics revolution. It calls for the return of patriotism--and the service to the country that comes with it.

Few in the United States other than the military and their families are paying a steep price in the war for survival that is now confronting our society. Vascular surgeons and other physicians must speak out as patriots. Our country's interests must be transcendent. Vascular surgeons and others must expand their efforts to support the military by volunteering to serve for short periods and by playing a large role in disaster planning and preparedness organization. We must vocally support our country's actions to protect our future. Hopefully our patriotism will become contagious.

Clearly our society is in a crisis, and, as usual, the crisis is mostly of our own making. Most of it is related to our current and recent-past systems of individual and group ethics and motivation. It is widely acknowledged that these systems have to change radically, and soon. This applies to medicine and to society. If the changes begin in vascular surgery, hopefully they will spread to other parts of the medical profession and then to other parts of society. These changes can only be helpful to all Americans--and maybe even to most of the world.