Professional regulators have betrayed their members and, with them, the people they serve.
“Medicine is a social science, and politics nothing but medicine at a larger scale.” – Rudolf Virchow
Healthcare’s regulatory colleges have always concerned themselves with notions of ‘professionalism.’ They are, at least bureaucratically, the ultimate arbiter of how the term is interpreted, policed, and, in the case of a breach, remediated. While their primary responsibility is to the public, college administrators know full well that healthcare is a unique occupation—“it’s not a job, it’s a calling,” as the cliche goes—and that disrupting it is no small matter. Because these institutions hold our careers, including the personal sacrifices needed to get there, in their hands, they must exercise the utmost care—the utmost impartiality—when meting out punishment.
Until recently, it appeared that our administrative overlords understood this. Their relationship with healthcare professionals may have been strained at times, but everyone knew the score. In 2020, that all changed. Like countless others, the term “professionalism” was filtered through the lens of the ideological takeover that affects us all. Times change, but it seems our times change quicker. Seemingly overnight, the standards of a once venerable vocation were obscured.
In 2015, I had dinner with a small-town physician who had become a kind of mentor to me. He was of an era when generalist physicians did just about everything—cradle to grave, head to toe. He was also from a time when physicians were somewhat separate from those they served. Not above, just separate. It simply came with the territory. “No one in this town has ever seen me with a drink in my hand,” he told me as he dutifully sipped a glass of water, “and they never will.” This was not a pompous or prudish man. He understood that his behavior in public mattered.
Contrast that perspective with our current state. Late in 2020, medical Twitter took a break from self-flagellating about its supposed racism in order to adjudicate a manifestly millennial scandal. The impetus was an article published in the Journal of Vascular Surgery, whose authors had had the temerity to question the wisdom of (mostly) female surgeons posting sexy photos of themselves on the internet. The authors (who were male) argued that Instagram bikini shots and their ilk were unbecoming of medical professionals. Not so, according to progressive medical Twitter. A group of men had no business dictating to young, suntan-loving surgeons what is and isn’t professional! If they wanted to show the public what’s hiding under their scrubs, that was their right. The article was promptly retracted.
As I say, things change, and reflexive hysteria about “policing women’s bodies” is the least of it. In recent years, the notion of the thoughtful, engaged doctor who enters public discourse as a learned and trustworthy figure has been replaced by a veritable ocean of glib physician-activists whose primary purpose seems to be to remind us all that professionalism is now defined relative to one’s position on the political spectrum.
[Related: “White Coat Radicals”]
Politicizing professional behavior is a bad idea regardless of who does it, but if the new normal had been a true free-for-all, medicine might not have imploded the way it has. If everyone, of every ideological stripe, was permitted to be overtly and aggressively political, all would perhaps have come out in the wash. The profession wouldn’t be the same, but at least we would all be held to the same standards, and that would be something.
Unfortunately, that’s not what happened. Instead, tolerance for public commentary was limited to the progressive (and then radical) left. You could rail against “whiteness” with your title and institutional affiliation on display, or create a group called “Doctors for Defunding Police,” and be praised and supported, but it was professionally dangerous to criticize this destructive mindset. You could call for vaccine skeptics to be denied healthcare and libel colleagues opposed to lockdown measures, but you risked your career if you so much as suggested that it was a touch draconian to arrest people for walking their dogs past curfew.
While he is not a medical doctor, the well-known case against psychologist Jordan Peterson by the College of Psychologists of Ontario is a good example of what medicine (and, really, all professions) has become. Peterson is no longer a practicing psychologist, and hasn’t been for years, but his regulatory college still thought it necessary to act on (clearly) politically motivated complaints about his social media conduct, which included strong words about Prime Minister Trudeau, un-minced revulsion at the practice of “gender-affirming care” (especially for minors), and other critiques of what he sees as a dangerous political agenda sweeping the West. The proposed “remediation” included saddling this intellectual giant with a DEI minder who would, among other things, decide when his pound of flesh had been sufficiently extracted. The ideological capture required to motivate such a campaign against such a person boggles the mind. Peterson’s uncompromising defense of free speech and contempt for all things radical left is, from where I sit, the minimum vitriol all of this deserves. But, really, that oughtn’t to matter. He could be the far-right boogeyman he is often claimed to be, and, given the far-left bias in contemporary medical institutions, his views would still just be a drop of pushback in a sea of progressive sanctimony, lying, and cruelty.
One way or another, something surely has to change, but I remain conflicted about what that change should be. If it were up to me, medicine would be largely apolitical, and physicians would refrain from public activity that might reasonably suggest apprehension of bias. With some caveats, this was the de facto reality until very recently. Admittedly, renewing such a standard might call into question some of the things I have said (and probably will say), but at least patients could feel that their care was impartial once more. The problem is, for many of us, trust in medical institutions is dead. The censoriousness of our medical betters vis-à-vis COVID policy, BLM, trans activism, Indigenous issues, and every other “woke” preoccupation left a trail of disillusionment in its wake. Thus, before any ceasefire could be accepted, our regulators, journals, educational institutions, legal organizations, and professional associations would have to be cleaned out, top to bottom. Every DEI bureaucrat and lackey would have to go, every leadership position would need to be re-staffed, and every one of the far-left social media scolds screaming into the ether about the injustice of long division would need to be issued cease and desist orders.
The other option is to forcibly change the range of acceptable discourse such that true pushback is once again permitted within the profession. This seems to be happening slowly—I bet that, pretty soon, we’ll be able to (politely) ask questions about mastectomies for minors without putting our licenses at risk. But fighting fire with fire (even against a pernicious ideology) has its own liabilities. Right now, medicine’s Overton window is as narrow as the minds that enforce it, and blowing it open might truly be the only way to save it from itself. But politicizing a profession like medicine—whose very raison d’être is to treat all patients as individuals according to need—is wrong, no matter how righteous the cause.
[Related: “Are Woke University Policies Killing People? They May Soon”]
In a perfect world, I think Peterson’s (and some of my own) online conduct would be reasonable grounds for a professionalism warning. Not some disgusting show trial adjudicated by sanctimonious party men, as is currently underway, but a letter from a responsible and ethical regulatory body saying something like, “Dr. Peterson, we respect the right of our members to disagree and disagree vociferously about issues that affect their patients, but we request that you consider the importance of decorum in maintaining the trust of society at large,” would not be the end of the world. Professionalism is a real concern. So is professional regulation (and, in the case of medicine, self-regulation). In choosing this line of work, we forgo certain luxuries afforded to the rest of the population. I don’t think it matters much if the person fixing my car talks a lot of bollocks on social media. But apprehension of bias matters in professions where we have access, by definition, to the most vulnerable parts of people.
The defense I have seen of Peterson and others like him has tended to focus on free speech and the fact that none of the complainants appear to be his patients or colleagues. This carries some water for me, but I don’t think it’s enough. Today’s made-up definitions of “harm” and “bias” are unhinged. And the colleges’ willingness to selectively investigate complaints of the most political and vexatious nature is corrupt and unbecoming (and probably contravenes their own policies in letter as well as spirit). But I don’t think this is a simple free speech issue. I don’t think expecting decorum or restraint from healthcare professionals is outlandish. And I don’t think we should be able to say whatever we want so long as it’s not at work. This is why most institutions (even pre-2020) care very much about conduct “while identifying yourself as a member of [insert workplace].” In a sane world, that’s not a bad standard.
In response to his pushback against the apparatchiks at the College of Psychologists of Ontario, Peterson was asked by the CBC what limits, if any, he thought there ought to be on speech for professionals like himself. Given our age, he was, of course, asked whether a psychologist or physician or nurse or lawyer should be able to say something overtly racist on the internet and then go to work the next day without undermining the profession. Peterson’s answer, as is his way, was unflinching: “If you grant a board the right to bully speech outside of the narrow purview of professional interactions with clients, then you open the door to ideological capture of the colleges … [which] of those is a bigger danger? It is not obvious.” As things currently stand, he’s right. Our regulatory bodies are ideologically compromised to such an extent that I, too, question the wisdom of giving them the power to adjudicate anything beyond the coarseness of their morning coffee grind.
I wish things were different. I wish the professionalism of my friend, the small-town physician, was the norm—private, dignified, and patient-first. Our patients don’t need medical Red Guards. They need thoughtful, objective professionals. Right now, by dint of their own ideological capture, professional colleges are making this increasingly difficult. Standards are not the problem—double standards are. But until something like common sense returns to our world, medicine seems destined to remain a front in the ongoing culture wars. Whatever else that means, it is a tragedy.
Image: Adobe Stock
It will be interesting to see how the COVID politics shakes out over time — here in the US, I’d love to see a Republican majority in the Senate so Rand Paul (who is an eye surgeon) subpoena Fauci and the rest for hearings. There’s a lot coming out about that Chinese lab in Wuhan and US funding, and it’s going to be interesting to see what the popular reaction is going to be.
A century ago was the height of the Eugenics movement and then there was the horror of the Holocaust and that was the end of it. If it comes out that COVID was man-made, which increasingly appears to be the case, I can see a similar visceral reaction against the medical bureaucracy.
But the politicization of the medical profession is scary.