The DIALECTIC: MOC is dead. MOVE ON!

A curious idea came into my head the other day. A concept, really, as it  furnished itself into a full blown thesis. You might ask what the thesis was about. That…

Man is meant to fly!

Looking at those creatures that take flight under their own power, the answer would be no. Man therefore was not meant to fly. That then is the original antithesis.

Yet when I look at the airplanes, man has learnt to utilize material to allow himself to fly through the air. True that! And recently the Jetmen who flew over Dubai, suggests that man is coming closer to the original hypothesis of man is meant to fly. This then is the new synthesis.

The dialectic proceeds and furthers our notion that we as humans go boldly “there” wherever “there” is because it is there. The original thesis continues to be reframed by the antithesis. The mind forces the world and brings it to its knees. Space and time are forced through the dialectic of a mind into substance and causality. And eventually the antithesis reforms the original thesis; “Man is meant to fly but with an assist!” This might change in the future, since there are antithetical arguments already in place to re-synthesize the newly reformed thesis.

The universal paradigm of giving birth to a thesis also leaves a constant trail of evocative pebbles in its wake. Not every concept takes flight after all. Each pebble a “run in with the antithetical monster,” is a constant reminder of how the world is shaped. Each pebble an outcast, lost in the whirlwind of the antithetical argument, never to realize its goal. In golf there is a truism about putting, “Not up, not in.” That is true for the discarded pebbles in the trail of a shaped reality. One such fresh pebble lies behind our last footstep, forced by the antithetical force of truth and finds itself heaped in the basket of ruined thought.

This thesis that lies bleeding, by a thousand cuts, is the Maintenance of Certification (MOC) requirement for physicians. Here the thesis propounds some fallible arguments pitched only by the conflicted souls of the organization. The originators of the MOC, ABIM/ABMS, claim there is a need for MOC and the importance of MOC is for the benefits of the patient care; public good is implied. Hidden, but recently revealed, is that there is no benefit to either the patient or the physician from MOC compliance, except only to the agency (the ABIM/ABMS), that collects millions of dollars in fees pays the officers handsomely in 7-figures and then plows the remainder into the ABIM Foundation.

The thesis suffers another deadly and paralyzing blow when it is revealed that the chief and pilot reason for this thesis to take shape in its current manifest form is to rake in money to avoid the organization from falling into the abyss of bankruptcy. Meanwhile, the money flows from the guileless physicians and the system lavishes itself with the royalties from the same distracted, confused and easily persuaded group under the guise of “do no harm.” Ah the muddied waters get muddier by the hour. The blows are many and the MOC’s outstretched limb for regulatory help might be a bit late to resurrect its image of a once beloved and dedicated organization. Indeed money has re-framed the shiny robe into a moth-eaten fabric of greed. The environment has decayed, ripe and teeming with the entozoon.

The only correlate that I can find to the MOC phenomenon is a malignant leukemic cell that thrives in its micro-environment where it is fed by supporting cast of other like-minded cells to prosper and proliferate at the detriment of the host. Sad but true. That is the Yin and Yang of life. To kill the beast or perish under its weight.

The antithetical argument to MOC seems to have found its stride. MOC was never meant to be helpful to the patients and their physicians - this much is well established. The original tenet was faulty! The antithesis is robust. Hence no synthesis is possible. A human response antidote is needed. The dialectic is fractured. The vein of fiction is ruptured and the vessel exsanguinated. There is no life to support here. The EKG is flat lined! No breath, no pulse, nothing! The thesis is dead! 

Move on!

But, “No,” say the enriched tarnished brass pining for the polish to shine, “The MOC is dead. Long live the MOC.” Apparently the new/old thesis has not been fully realized by the players yet. The old verified and validated thesis being, “CME is still king.” NBPAS (National Board of Physicians and Surgeons) seems to understand that very well and so do most 97% of the physicians (based on a SERMO survey).

“Move On!”