From the President...

"Insouciance"

Robert R. Urban, MD


It has been said that there is no such thing as coincidence --- that all happenings have their reasons. Several days ago, I was conversing with physician friends about the reasons for the current medical and professional dilemma, physicians and patients finding themselves hopelessly overwhelmed by the government and the insurance industry. On the following day, while purging files in my den, I came across an article on this very subject, which I had written in 1995. The article went like this:

"As the Fall issue of The Seppian is about to go to press, I feel compelled to speak out on a deep concern and a pet peeve of mine. The French have a word for it --- insouciance --- light-hearted unconcern. Some other synonyms are apathy, disinterest, indifference, disregard, heedlessness, lassitude, lethargy, listlessness.

"Does this sound or 'feel' familiar? I'm sure it must, because wherever I go, it seems to be there. I find it so easily, in medical, or more specifically, physician places as doctor's lounges, staff meetings, hospital corridors, making rounds, CME meetings, anyplace where physicians gather. Why is it that physicians, of all people, feel intimidated and overwhelmed by every possible threat, whether it be the malpractice debacle, government interference in our daily work, or the current managed care phenomenon?

"Once, not long ago 'doing your job' was enough. This is no longer true. To protect ourselves, and our patients, from being gobbled up by the lawyers, the government and now the insurance company 'brokers' of medical care, we must rid ourselves of 'insouciance,' or believe me, we will be transformed from professionals to technician robots, under the complete control of government, insurance companies, and HMOs. I will admit my impatience with those who feel that our future is sealed in this manner. I do not believe that this trend is inevitable, or more importantly, that there is nothing we can do about it. I will remind you, once again, that physicians are the only ones; yes, the only ones, who can properly diagnose and effectively treat, the sick and injured. Think about it. That gives us the 'power,' and the responsibility, to take control of our profession from the politicians, lawyers, government, and HMOs; and in so doing, regain our ability to give the best possible care to our patients. Isn't that what we are supposed to be all about?

"Maybe that's why I'm eagerly awaiting the annual meeting of the Association of American Physicians and Surgeons in Falls Church, Virginia, on October 11-14, 1995. AAPS meetings, much like our local SEPP meetings, strike me as beautiful oases in the barren desert of our profession's indifference. At these meetings you actually find yourself surrounded by physicians who haven't given up, who are willing to speak out, and do stand up to the lawyers, politicians, and insurance companies who are so rapidly changing our chosen profession into a serfdom invoked and administered by insurance brokers of medical care. I will see no suggestion of 'insouciance' at the AAPS meeting.

"Recently, I ran across a pertinent quote by a non-physician, Elie Wiesel, Rumanian born journalist/author, who was also troubled by this phenomenon. Here's what she thought: 'The opposite of love is not hate, it's indifference. The opposite of art is not ugliness, it's indifference. The opposite of faith is not heresy, it's indifference. And the opposite of life is not death, it's indifference.' Think about it and try to remember that we have the power and we must assume the responsibility to do what is necessary for our noble profession's very survival, and most of all, for our patient's good health. No one else will, or should be expected, to do this for us."

Well, that was the article, including my explanation of the impending tragedy about to descend on our profession. Now, seven years later, I can see even more clearly, that "beautiful oasis in the barren desert of our profession's indifference." Yes, AAPS is now even more clearly focused on the problems and the solutions than ever before.

It is truly the only medical organization which has not been intimidated by the government and the insurance industry. When the Clintons' secret task force tried to socialize American medicine in 1992-1994, it was AAPS who successfully challenged them in federal court, with the litigation culminating in a stern rebuke by Federal Judge Royce Lamberth and included sanctions against the government.

This group of physicians obviously has the stamina to stand up to today's threatening barrage on patients' and physicians' rights, and has what it takes to get the job done.

In the media, in state and federal courts, in the halls of Congress, at state licensing boards, and in Congressional committee hearings, you'll find AAPS fighting the good fight, always standing up for patients and physicians.

So, to all of you out there who are members of AAPS --- hold your ground! And be ready to forge ahead! To those non-members reading this --- we need your help! Come aboard the good ship "AAPS," where apathy has been replaced by activism, and "insouciance" is considered a dirty word.

Dr. Urban is the President of the Association of American Physicians and Surgeons, founder and past president of the Society for the Education of Physicians and Patients, and practices medicine in Belle Vernon, Pennsylvania. His e-mail is: urban@sepp.net.

Originally published in the Medical Sentinel 2002;7(2);43. Copyright©2002 Association of American Physicians and Surgeons (AAPS)