The American Medical Association (AMA) would have you believe that the greatest threat to the medical profession is “scope creep”—the infiltration of advanced practice providers into the medical practice.
The way I see it, it’s not a big deal; The movement will reach equilibrium, and everyone will play nice in the sandbox.
In my opinion, the greatest threat to the medical profession is “political creep”—increasing government intrusion into medical matters.
First, it was abortion, in which the Supreme Court overturned Roe v. Wade. Now it’s transgender youth, with the state of Florida moving to ban gender-affirming treatment and other states considering it.
Despite the scientific rationale and support for gender-affirming treatment by the American Medical Association, the American Academy of Pediatrics, the American Psychological Association, and the Health and Human Services Office of Population Affairs, Florida politicians managed to remove evidence-based guidance documents is of. down our collective throats to act on their own agenda. They want their nonconsultative guidance document codified into law.
The most appalling aspect is that in Florida, only a few elected officials have power and can control medical decision-making, a fascist-like authority over medically trained individuals, while potentially allowing like-minded states to turn it into a medical wasteland of backward science.
Turn the clock back 50 years, and you’ll see that “homosexuality” was considered a mental illness. However, only one medical organization—the American Psychiatric Association—required to correct that egregious error. Politicians were never required to be consulted or approved in order to classify homosexuality as a mental disorder.
Thanks to the tireless efforts of some gay activists in the early 1970s, Dr. John Fryer was the most notable of them, having homosexuality removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM), giving millions of Americans a “cure” overnight. ,
Today, it’s not that simple (not that it was easy for Dr. Fryer and colleagues). The problem for children and teens with gender dysphoria isn’t diagnosis—it’s treatment: puberty blockers, hormone treatments, and gender-reassignment surgery. Florida’s ban would prohibit these treatments as well as psychotherapy.
Politicians feel they need to control medicine because sex change can be irreversible, and children and adolescents lack the capacity to make decisions. However, like other complex situations in medicine, sensitive medical concerns should be handled between doctors, parents (or designated surrogates), and medical experts.
If Florida has its way, even social gender changes (eg, name, pronoun, hair and clothing changes) would be taboo. Two recent studies, one published in Pediatrics and the other in The Lancet Child & Adolescent Heath, found that most transgender youth are stuck with their new gender identity.
Instead the Florida authorities preferred to use the Merck Manual and other questionable sources to organize their case. That’s fine with me because even the Merck Manual admits that “there is no conclusive research to guide [the] Decision Regarding Medical Transitioning of Prepubertal Children with Gender Dysphoria”. Why is Florida banning it if no reputable source provides a scientific basis for prohibiting transitioning care for transgender minors?
To do so seems wrong and unnecessary because the goal of therapy in gender dysphoria is laudable—that is, to align patients’ physical appearance with their perceived gender. Doctors don’t need an army of politicians to decide how to do it. Politicians don’t belong in doctors’ offices.
Doctors who are against assisting minors and their parents can refer them. But before they dismiss them, doctors must realize that gender dysphoria is severe enough that it is associated with clinically significant distress and impairment in social, school, or other important areas of functioning. Gender dysphoria is not an artificial disorder or phase of life. Patients should not be used as political pawns.
To be sure, there are many areas of medicine other than fertility and gender identity where the government has overstepped its authority. Martin Merritt, a health care attorney in Texas, writes: “Virtually every federal regulatory concern currently driving the modern practice of medicine was present in some form in the 1950s.” He cites medical coding, billing, advertising and off-label prescribing issues.
Federal crimes include the Stark law, anti-kickback statutes, HIPAA, and Medicare laws, which correspond to Title 42 of the United States Code, which includes civil rights and health and human services laws. Merritt concluded, “Many fear, and rightly so, that as the health care insurance exchange offered on healthcare.gov becomes fully operational, a federal takeover of the practice of medicine may soon be complete.” Will be done.”
Government interference is almost universal when it comes to mandatory electronic health records (EHRs). EHRs have disrupted and exploited the patient-physician relationship. Excessive assessment and management documentation requirements consume time in patient care and make it difficult to locate relevant medical information in patient records.
Intrusive government regulations and mandates of various insurance plans have caused patients to move from plan to plan – and from doctor to doctor – causing the concept of patient-centered care to be diluted and in many cases lost. What a good idea for Florida parents to “reach out to your child’s health care provider for more information [about gender dysphoria]When their provider is constantly changing? In addition, Medicaid would not reimburse the treatment under Florida’s proposal.
Former CMS administrator Seema Verma ran into controversy, partly because she called for less health care regulation and more free market competition. She was certain that a reform would be to redirect the American health care system away from government regulation, allowing physicians to compete on cost and quality and allowing patients to make their own decisions about their care.
Government regulation of reproductive health and mental health has exacerbated the predicament. As a psychiatrist, I know a lot about mental health, and what is clear to me is that the American mental health care system was founded on the principles of humane treatment and scientific inquiry—on the backs of political hacks. No. Those who depend on voters for their livelihood. Where did he get his medical education?
Physicians and patients were once relatively free to contract for services in the way they saw fit. That saying no longer applies. The medical profession has gradually come under the sway of the politicians exerting pressure. Politicians now set the rules and regulations under which physicians practice. Scientific truths have become inconvenient, sidelined, ignored, or labeled conspiracy theories.
Increasingly, state medical boards have come under attack from political creeps. Most of the board members are appointed by the governors of the states. Knowingly or unknowingly, their decision-making is influenced by statewide politics, not the way physicians are influenced by pharmaceutical companies. It is all too easy (and convenient) to punish doctors when medical boards are held hostage by the regime of political ideology.
A senior fellow at the Cato Institute, Dr. Jeffrey A. Singer said that government has “killed” the medical profession: “Governments and hospital administrators have all the power, while doctors – and worse, patients – have none.”
The AMA’s Code of Medical Ethics states that physicians should work to change unjust laws. However, apart from opposing government intrusion and the criminalization of medical procedures, the AMA has been powerless to affect change. Simply put, the medical profession has lost its grip on the autonomous practice of medicine. The US health care system is dominated by the government rather than medical leaders and experts.
The sad part is not the abrogation of individual liberty by the government; Rather, it is that political leaders have cowed physicians and censored those who might give a voice to patients in need. Unchecked, the government will abhor the power to resolve complex medical issues and arbitrarily change medical regulations.
Arthur Lazarus is a psychiatrist.
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