Saturday, June 18, 2011

"Thus Conscience does make Cowards of us all…"

The sea of tranquility oft times is roiled by the deep fissures between moral and unethical thought. From the Calvinistic “battleground” where human thoughts clash with the Kingdom’s imperative to the theological reasoning enjoined to do good and avoid evil, life is lived on the fringe. And yet what pricks the bubble of existence is this seat of universality or Emmanuel Kant’s “Categorical imperative.

Conscience is pithy, Einstein’s “Inner voice,” or Schopenhauer’s “mirror to the will.” It makes us resent our inaction but then equally congratulates us for it. It allows us the freedom of thought yet corrals us within safe bounds that prevents chaos due to deviation from societal normative values.  Conscience is a traitor to selfish desires and also the seat of a harmonious existence. It is a contradiction!

It is this contradiction that Shakespeare had in mind that prompted his Hamlet to say, “Thus conscience does make cowards of us all.” He was after all referring to the mystery of death and the conscience of doing right over wrong to avoid the gates of hell. It is that very motive and that very morality that forces the physician from a militancy of action into servility. For the conscience that pricks and awakens one at night at the thought of another human being’s misery, is that very voice that also prevents the physician from glorifying the self.

What has happened medicine, is the vortex created by the volatile world of business and politics that has trampled upon the nobility of the most glorious of all professions. This profession made noble through the ages for helping life and steering away the curse of illness from another being has been vilified and victimized by society at large today.

Not a day goes by that the medical profession is not de-conditioned and tramped over. There are accusations of fraud, impropriety, public health risks all borne of the health care industry. The finger points and a man or woman in a white coat with a stethoscope represents the “face”. The physician is no longer the healer of what ails the person but the causative agent of what ails people and the society. Once the angel of life, he is now considered the devil himself. The media regales in it, the politicians devour it for every meal to press forward with their agenda, the layperson caught in the middle of this drift follows the trail of the written and spoken word, unable to separate the wheat from the chaff. Oh! but for that banner of truth to free us all from the shackles of this malaise and drudgery.

Meanwhile using the pulpit of this destructive force, the powers use means to control and coerce through regulatory fiat the very practice of medicine. The litmus test of good medicine is based on its value at being cheap. The innovation is desired but not utilized for the masses. Under the spotlight of bright fiscal scrutiny, life is being demeaned and death is being regaled. It is a 180-degrees from when only yesterday life was rejoiced. Today age is being rendered as a curse and therefore quickly and expeditiously to be curtailed. The very trumpets that heralded every new discovery and each new success in the medical field are silent. Where have, “the rational principles congruent with nature and the universe” that the Roman Emperor Marcus Aurelius once touted, gone?

Something has gone haywire and yet the physician continues to toil. He works harder cares for more and is meted out with angry eyes and harsh words. His conscience pricks and he silences his own voice, for his oath must never be in jeopardy – above all do no harm. By expressing anger and militancy he risks the transgression across the “nobility-line.” He remains muted. He remains quiet and suffers from the perjury of the assembled. He has perforce embraced cowardice for fear of that transgression within his own conscience.

So are we as physicians cowards after all? Yes, and it is not a maybe! By coward do I mean handcuffed by our Conscience from exposing the great lie in a battlefield against the entrenched selective bias? Yes! By coward, do I mean that we want everyone to know the perils around the corner of the fake “yellow-brick-road” ahead but find ourselves stifled? Yes! By Conscience do I mean our innate desires as physicians to care for the sick and the unhealthy without the distractions that abound? Yes! Can anything be done? I think the answer to that is most certainly, yes! For now the physician psyche is glued to the delusional of when the natural reasoning is eventually restored the process of healing will finally take place. Nothing in this conversion of politics, business, fakery and fiat leads me to believe that, that will ever happen given the current format. Not until the conscience and cowardice are sewn together will the physician voice be heard. Until then we might as will bow to the king, “The king is dead, long live the king!” But maybe, just maybe, there is hope, and then again hope is just another dirty four-letter word for inaction.

The single photon that escapes the darkness carries potential. That beam of light is the physician’s voice and it is being expressed. The pitch and volume is extremely low but it has been increasing. The squelch is diminishing and the clear expressions are arriving at the muddy shores. These lone voices are slowly emerging in the vast universe of the Internet. One day in not too distant a future the combined force of this displeasure will be expressed in unity and the evil that surrounds and occupies the periphery will cede control back to the rightful owners of this noble profession. And once again we as physicians will be able to discuss the matters of health, heal and comfort the sick and do for our communities what we do best without the distractions of fiscally mediated intrusions. As John Ralston Saul said, “... consumers risk turning over their conscience to the technical experts,” he was early by a few years. Ah! There, behind that great mountain is our Shangri-La. We just have to find it again.

Legions of characters surround this profession not only to gape at it in wonderment but also to partake in the bounty of its goods. They see potential for themselves and their companies. They advocate, promulgate and create various ventures to make the art of the practice cheaper but their eyes are always on their own bottom line. The snake-oil salesmen are at it again in pinstripes and slick hair. There are traps upon traps hidden within this mosaic called medical practice. The physician who now has been relegated as a ”provider,” must find clues and artfully avoid these pitfalls. All these distractions are there to prevent him from realizing that he can control his own destiny. And all this smoke is not from fire but  a nebulous vapor amplified by mirrors as distraction. Ultimately saner minds and calmer demeanors will prevail in this most noble of all professions. One day soon when the epitaph has been written and the ashes have been wept over, the phoenix of this nobility will rise again. I am confident!

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