“If you do not take control of your life, someone else will”☆

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On a recent trip to Italy to attend a meeting of the Italian Neurosurgical Society, I talked in detail with 2 neurosurgeons about the practice of medicine and neurosurgery in Italy.

The first neurosurgeon mentioned to me that all neurosurgeons are paid by the government and paid exactly the same wage. As a result, he said that there was no incentive for anyone to work harder than the next. Even the residents do not read because it will not matter to their income. He had a personal satisfaction that led him to work hard and treat many patients, yet neurosurgeons nearby did only 20% of the cases he did with the same pay. This lack of incentive, he said, is the result of a socialistic government and society. “Meritocracy,” or being rewarded for what you achieve, as he believes, exists in the United States, but does not exist in Italy, or for that matter, most of Europe and the rest of the world. “Egalitarianism” he said (socialism, by another name, in which everyone is treated and awarded the same), does not work. That is the system in Italy.

I asked a second neurosurgeon why neurosurgeons and doctors do not organize or band together to get power. I was told an endless series of excuses, such as, “I am tired when I get home from work,” “I do not have the time,” “It will not make a difference,” and so on. I asked him if he did nothing what would happen in the next 5 or 10 years, and he agreed that the situation for medicine and doctors would get worse—yet, he was totally defeated, as are most doctors around the world. They have been defeated by politicians and governments against whom and which they think they have no power.

Doctors have power. There is no one else who can provide medical care, and if doctors find the things common to all—which are important to them as a group—such as: (1) better pay, (2) less control of their medical decisions, and (3) improvement in the quality of medicine for the public (and they agree on these things), then they could band together and would have power.

I found the same attitude at the meeting of FLANC, the Latin American Federation of Neurosurgical Societies, held in Bogotá, Columbia, in October 2008. The neurosurgeons with whom I talked all agreed that the above issues are the ones that are of concern to them, but they are leaderless in dealing with them, except for Brazilian neurosurgeons, whom I have described before as being the best organized and the most effective in dealing with their government. However, few are asking the Brazilians how they have succeeded.

The recent election of Illinois Senator Barack Obama, who will has now succeeded President George Bush in the United States, and the recent presidential election politics have striking parallels to the situation of doctors and medicine worldwide.

From the day Bush became president 8 years ago, there has been daily and incessant criticism of him and his policies by the press and the left. Amazingly, he is blamed for everything that people believe is wrong. He has become the scapegoat for everyone and every nation's problems. If this same attitude were used against blacks, or any other group, there would be huge criticism that the perpetrators were prejudice. Yet, that sort of rationale escapes those everywhere who criticize the president.

The press and others bombard the public with poorly substantiated information, criticizing the Bush administration about issues that the public accepts without proof or examination. The criticisms include, the worldwide economic disaster; the falsification of information about the reasons for invading Iraq and persisting there; the inability of the coalition forces to defeat the terrorists; the statements by the Bush administration that Medicare and Social Security will go bankrupt; the high price of gasoline; the poor status of the United States around the world; the failure of Middle East negotiations; the response to Hurricane Katrina; and any other problems that have occurred. I have heard these criticisms echoed by neurosurgeons and others in Africa, South America, and Europe; and President Bush, himself, did little to counter these criticisms.

Actually, none of these accusations are true if one takes the time to examine the facts behind each. The war in Iraq is being won; the terrorists are being defeated and are leaving for Afghanistan, Africa, and other countries to cause trouble in those places; and the Medicare and Social Security systems will be bankrupt by 2017 and 2041, respectively, according to government reports.

The failure of both political parties to act for the past 30 years has made the United States dependent on others for energy—offshore drilling and the use of clean coal have been discouraged. In addition to the negative influence of the environmentalists, all these criticisms have cost the US taxpayer a 4-fold increase in the price of gasoline and dependency on the monarchies and dictatorships that run governments still stuck in the Middle Ages. Yet, most in the world do not agree with US policies. So what? And no leader anywhere in the world has had much of an impact on the persistent state of warfare against Israel in the Middle East. As far as Hurricane Katrina is concerned, yes, there was government ineptitude, but the graft and corruption in Louisiana that led to the misuse of federal taxpayer dollars allocated for the building of protective walls to prevent river flooding was also a principal cause of the disaster. Little is ever said about the latter point. Why? Because scapegoat criticism is easier.

How did all this misinformation occur? People all over the world are surprised when I tell them the facts. They have never heard that before, they say. Why? Because the press has given the public biased information that few have bothered to verify. A recent study by the Pew Research Center, Washington, DC, in the United States (Investor's Business Daily; November 12, 2008; “Uncommon knowledge”), found that most of the information produced by the press in the United States is leftist in tone and content. I have asked people all over the world if they believe what they read in their newspapers, and they uniformly say, “No.” One Italian lady asked me for evidence that the war in Iraq is being won. I cited news that is available in any newspaper in the world to the discerning reader. The terror acts have dropped sharply; the factions in the government have united to defeat the terrorists, as in Anbar Province; more oil is being produced than during the Saddam Hussein regime; the country has its own army that is assuming control of more of the country each day; and the government is making decisions that parallel a democracy—a far distance from life under Hussein. Yet, this Italian woman was under the belief that nothing was happening. Why? What information is she and others getting from the news media? Who is telling people the facts?

What does all of this have to do with doctors and medicine worldwide? The public has been brainwashed everywhere that the quality of medicine provided by physicians is bad, the costs are high, and that the only solution is for the government to control medicine and the doctors. Then, everyone can have health care and the cost will be less or free—all of which is totally false. In the United States, doctors are accused daily—via the press—of abandoning the health care of the poor, that 15% (45 million) of the people in the United States do not have health insurance, that the infant mortality in the United States is higher than many countries in the world (Investor's Business Daily;March 30, 2007), and that our health care is not as good as other countries. The US automobile companies blame their failure on the high costs they pay for health care. Newspapers and a government organization, the Institute of Medicine, state that doctors cause almost 100000 deaths from medical errors in hospitals each year (JAMA;284:93-95, 2000). Doctors, worldwide, must really be bad is what the public is led to believe.

All of the above claims are also false, but not even doctors critically examine what is told to the public and believe what is said. They and the public accept what the press and politicians say without doubt. Yet, doctors do not do this with a scientific article, and besides, doctors do not respond to these criticisms anywhere I have been in the world. Why not? Maybe the reason is that they are as defeated as the Italian neurosurgeon or neurosurgeons I have talked with all over the world. The misinformation is too great for them to challenge. For example, it does not even make any sense that the United States is ranked 39th in infant mortality in the world. Even if all the developed nations in the world were better, that number is less than 15, and it is impossible to believe that the United States is behind 24 developing countries. In addition, infant mortality statistics are reported differently in countries around the world, and infant mortality is defined differently in many countries. Even the World Health Organization states that this difference in reporting is the case. So, we are seeing a comparison of incomparable statistics that are reported in the newspapers that everyone immediately accepts. Why?

Physicians have a Bush problem: they say nothing in their defense. By doing so, their opponents claim victory in the eyes of the public. Former President Bush's greatest flaw is that he is not a good communicator, whereas President Obama is a superb communicator, but what he says is not substantiated either. The press did not pursue his superficial promises and statements either, and in other cases, did not publish what they thought would be critical of him. All of the evidence from his background, voting record, and statements support that he is a socialist. Yet, no one wants to use that word. Only time will tell what Obama's record will be. I even spoke to a group of neurosurgeons about the health care positions of both candidates, but some in the audience were reluctant to accept the truth about either candidate. Their minds were made up emotionally; the facts did not matter.

So, this is a public relations problem that doctors have worldwide. They and their medical societies believe they are powerless to deal with this problem. They are defeated like the Italian neurosurgeon, along with neurosurgeons and doctors worldwide.

Think of this idea: in the United States, as is true in all other countries, the public (our patients) visits doctors throughout any given year, and in the United States, by a rough calculation, there are 1 billion visits from the public to doctors each year, which means that each patient is being seen many times by doctors; patients have great faith in doctors. Do doctors, worldwide, take a few minutes to explain to their patients what is going on in health care and what their opinion is so that the public (their patients) should know? It is simple to do and effective. Doctors have the largest lobby or support group in their countries: their patients, who are the public. There are other steps that can be taken, but this is an idea to start you thinking.

What is at stake is no less than our future, our careers, the practice of medicine, and the quality of health care for the public. As I mentioned in my talk in Columbia, “If you do not take control of your life, some one else will.”