Et Tu, Medicus
In Shakespeare’s retelling, the assassination of Julius Caesar lies squarely at the feet of his friend Brutus, as expressed in the dying Caesar’s last words “Et tu Brute?” Though Shakespeare gave us great tragic literature, today it is known to be historically false. It was someone much closer to Caesar, Demicus Junius Brutus Albinus, not Marcus Brutus, who was able to convince Caesar to attend what would be his final senate meeting.
Over the decades, I have been involved in or became aware of many instances where a peer was no friend, though not rising to the level that did Caesar in. Physician protecting fellow physician, a white coat of silence, is an exaggeration for public consumption.
It began in college pre-med training. Some courses used material from specific books in the library’s reserve collection. Unfortunately, it was common when seeking an answer to find it blackened out, likely by another pre-med student hoping a leg up would improve their chance of admission to medical school.
Medical school began with an anatomy dissection lab. It included a cadaver shared among four students. On our first day we were warned that removal of body parts from the lab would result in expulsion. Recreating The Godfather, but with a human head, was frowned upon.
There was no formal mechanism to prevent students from turning a dissection into something resembling a crime scene, thus preventing others from recognizing the anatomy during an exam. However, a friend who attended another school got a two-year time out after shoving a fellow student’s head into a cadaver’s body when witnessing that student creating anatomical havoc, despite warning of the consequences. Was that student just poor in technique or acting purposefully?
After graduating and completing residency, a darker side of medical practice became evident. In medicine, lawyers may write the laws and regulations, but physicians become both their cover and enforcers. This is true at the local (hospital), state (board of medicine), or federal (agencies) levels, often with overlap.
At the local level, most physicians have hospital “privileges,” required to care for hospitalized patients. Medical staff rules, known as bylaws, are enacted, and enforced by a minority of physicians who comprise the Medical Executive Committee (MEC). Whether in medicine or politics, the character of those inhabitants is often quite similar; if you walked in with good intentions, your stay was based on other motivations.
The MEC ultimately determines requirements such as whether physicians should get yearly Flu shots, basing it on a claimed “safety” for hospitalized patients. Can the committee’s physicians point to Flu outbreaks or closures of hospitals emanating from unvaccinated physicians? The COVID non-vaccinations were treated similarly, despite the dearth of information justifying its use. No shot, no privileges. It comes down to power and control.
Hospital boards consist of laypeople with a smattering of politicized physicians. Years ago, at an after-hours meeting, a fellow physician told me that any issue brought before physicians at medical staff meetings relating to “hospital business” was already a “done deal.” The presentation to physicians was for show and our opinions were only that.
A successful physician friend of mine worked in a private hospital that merged with a university hospital. He rebuffed the university’s offer to become their employee. Shortly thereafter, his care of a hospitalized patient was questioned, triggering “peer review,” used in theory to ensure quality of care, safe and effective treatment, and professionalism. It can easily turn into a sham review. Removing a doctor from the staff can also remove a competitor.
legitimate role for hospitals.
There are times when physicians pretend to support fellow community physicians. A local for-profit hospital decided to entice physicians to increase the use of their facility using a structured physician buy-in. The physicians of one large group followed suit but ended up diverting care of their patients to another hospital. The head of that group told me there was little choice since the other hospital would have hired physicians to compete against the group if patients were not diverted. The losers were the physicians who purchased shares and saw fewer patients.
Another friend was a foreign medical school graduate, and upon completion took the required ECFMG exam. After residency, he practiced in Florida for about 15 years. Upon applying for a Pennsylvania medical license, the board manufactured a problem: his ECFMG certificate did not have an expiration date, instead it read “indefinite.” Can you pass what is essentially an exit exam more than once?
My friend received a letter stating, “incomplete file,” followed by a phone call requesting a meeting “so we can read this together.” In the end, the board relented. The tendency is to blame office personnel, but they represent the physician member majority of the state medical board, our fellow physicians who could end this nonsense if they chose, but they do not and will not.
In Pennsylvania, physicians are required to take an online child abuse course for license renewal. Even if you do not treat children or are retired from active practice, no course, no license. The rationale comes down to this: every licensed physician, 24/7, is responsible for reporting anything remotely suspicious for child abuse. Compare this to court rulings that the police have no duty to protect the life of a civilian while on duty.
The lines blur between state and federal physician-on-physician shenanigans. The COVID “crisis” brought this to the forefront. There were physicians who pointed out the non-scientific basis of many aspects of the COVID narrative or discussed or prescribed medication considered “off-label,” another manufactured issue. Some ran afoul of state medical boards, again, run by their fellow physicians claiming medical disinformation, misinformation, or malinformation.
I have had issues with medical websites, specifically their comment sections, and have been lifetime banned from two of them, one a physician-only site, another for medical personnel only. It is apparent that these sites do not want physicians discussing topics they consider “conspiracy theories.” Publishing in medical journals appears little different; toe the party line or else.
Finally, board certification in medical specialties was once optional and if obtained, was for a lifetime. This changed to retesting at set intervals, requiring many physicians to spend thousands of dollars and hundreds of hours in preparation. Not passing often leads to job loss. It became the foundation of the board’s multimillion-dollar business, run by select groups of physicians. Do PhDs redefend their dissertation or state lawyers retake their Bar? Science is never settled, and state laws change. So lives are at risk? Lawyers defend people on death row. Apparently only physicians possess a unique fund of knowledge.
Unfortunately, unity among physicians is a mirage and the examples I used only scratch the surface. While media may portray the focus of professional assault as coming from hospitals, attorneys, and medical insurers, too many physicians are involved as well. As in Caesar’s situation, it is not always easy to distinguish friend from foe. My advice to those entering the profession is to remain vigilant but keep in mind that one day they too will likely ask “Et tu, medicus?”
Image: AT via Magic Studio