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Striking Out

by David Stevens, MD, MA (Ethics)

It started at a Little League ball game instead of the doctor’s lounge. Bill and Jim had been friends since they suffered through biochemistry together at their state medical school, but the talk today wasn’t about old times. As Bill watched his son step up to the plate, he and Jim fumed over the notice they'd just gotten from their malpractice carrier. Soon every doctor in the state would get the same stomach-sinking bad news that every doctor dreads: tripled premiums.

Jim’s voice rose louder as he said, "I’m too young to retire and I don’t want to uproot my family and move out of state. Neither do you! There's only one thing that the lawyers controlling the legislature are going to understand. Every doc in the state needs to just refuse to show up at work one morning! If we don't do it now, so many physicians will leave the state that soon there won't be anyone left to take care of patients!"

What would you say to Jim? Should doctors go on strike?

The answer is an unqualified "no" but how would you defend that position? It is not enough just to say that it has been prohibited in medicine for over 2,000 years. Here are three key reasons to share.

First, medicine is an essential service. There is no way to withdraw services without adversely affecting access to healthcare. Even if emergency services continue, patients still suffer. Someone may be unable to get a prescription refilled for a life-threatening condition that is not diagnosed on a routine visit. Striking puts the doctor’s economic needs above the patient’s well being.

Second, medicine does not operate on an even plane. Despite internet services like WebMD and bookstores filled with health books, sick people are still at the mercy of their doctors. Physicians have the power to diagnose, operate and write prescriptions. They certify sick leave and fill out insurance forms. They hold the power in a very unequal relationship. That is why doctors have been held to the higher expectation that they will sacrifice their own desires to meet the needs of others. In return, society has historically lauded their virtue and bestowed on them respect, money and privilege. Striking abuses the power of the professional relationship.

Third, the practice of medicine is built on the foundation of trust. Patients reveal intimate secrets, expose their bodies and put their lives literally in the hands of their doctors. They do this with the confidence that their physician will always act in their best interest. For doctor-patient relationships to work well, each patient must have this assurance. So must the whole of society. Striking will be the death knell to patients and the public's already damaged belief in the medical profession.

Am I advocating that we do nothing? Absolutely not! As individuals and collectively we must do everything short of withdrawing services to ensure we can deliver quality healthcare to our patients. But if we strike, no matter how laudable the goal or desperate the situation, we will end up striking out.