Most, physicians choose to enter Medicine for more than “just” income opportunities. They are also motivated by altruism, and a desire to do good for the communities in which they served[i]. Physicians anticipated respect, which came from appropriately applying their knowledge and skills, as well as from knowing that both their peers and patients had confidence in them. In the late 1960’s and early 1970’s, physicians were respected and trusted. Surveys in this era suggested that 70% – 80% or more of Americans trusted or had confidence in medical leaders[ii]. In 1977 medicine was the most respected of American institutions. Today just over 35% feel similarly and medicine ranks sixth of seventeen institutions that were the subject of the surveys. This loss of respect for the profession of medicine likely is related to two facets.
Trust in American institutions has declined since the mid 1960’s, as many in the country became disenchanted with the progress of the war in Vietnam. In the first half of 1968, Martin Luther King, Jr. and Robert F. Kennedy were both assassinated. After these two deaths a general feeling of discontent seemed to overtake the country. This may have reached a boiling point when the 1968 Democratic National Convention, held in Chicago, was tarnished by large, loosely organized, protests occurring in Grant Park. Rioting after MLK’s assassination had already damaged large portions of Chicago and other cities[iii]. The DNC convention-related demonstrations were widely reported on TV and portrayed the city and its police in a negative light. Richard Nixon won the 1968 presidential election. In 1972, as he was running for a second term, the break-in at the Democratic National Headquarters in the Watergate complex in DC occurred. There followed a series of events, which eventually led to Nixon resigning, while facing the threat of impeachment for misuse of executive powers[iv]. The Vietnam War ended in 1975.Several commentators subsequently opined that the war was both poorly conceived and prosecuted. Many of these scandals were magnified by attempts by the perpetrators to cover up their activities
Public scrutiny of institutions such as occurred in the late 1960’s and early ‘70s had never been as intense. It continues. Whether the country has ever recovered from the loss of trust engendered by the Vietnam War and by President Nixon’s activities is not clear. Nonetheless, from the mid 1960’s to mid 1970’s there began a growing public disenchantment with the institutions that should be serving and protecting them.
In the period from the 1970’s to mid 80’s Medicine had a similar series of widely reported mis steps including unethical or unsafe behaviors. Consider the report in 1972, of the conduct of the Tuskegee syphilis study, which simply observed and withheld effective therapy for men with syphilis. This happened in spite of the discovery that penicillin was curative.[v]. In addition, as insurance became the dominant method of paying for health care, a part of the relationship between physician and patient began to unravel. When the Health Maintenance Organization concept became formalized in the early 1970s, patients became further separated from the payment for health care. Large numbers of the general public began to suspect physicians of “rationing” or “denying” care in order to save money for themselves and their HMO employers. While these events were occurring, patient advocate and attorney activities encouraged an environment where patients and physicians could potentially becoming adversaries. In addition, in 1984 a highly publicized death of a young student, Libby Zion, in New York, made the public more aware of the potential for fatal medical errors[vi]. Several years later, the National Academy published its seminal book, “To Err is Human”[vii], which was said to “break the silence that had surrounded medical errors, their frequency and consequences”. This led to greater public awareness of the limitations of medical practice.
The combination of publicity of medical misadventures, the interference of outside stakeholders with the physician-patient relationship and the evolution of a distrust of institutions in general, have contributed to the loss of stature and respect for a once proud and respected institution – the practice of medicine.
[i] These communities consisted of the community of peers (other physicians), the community of their individual patients and the community in which they lived.
[ii] http://news.gallup.com/poll/1597/confidence-institutions.aspx accessed 6/7/2018
[iii] I was a house officer, living in University of Illinois Hospital Staff apartments on Marshfield St. From my 6th floor window facing west the night sky was red with burning fires for several days after Martin Luther King’s assassination in early April of 1968
[v] https://www.history.com/news/the-infamous-40-year-tuskegee-study accessed 6/1/18
[vi] at this time, there were many more increasingly potent drugs available than ever before. These more potent medications had the potential for great harm as well as great good. Mistakes made in the 1950’s and 1960’s simply didn’t have as much potential for harm or benefit.
[vii] Institute of Medicine. 2000. To Err Is Human: Building a Safer Health System. Washington, DC: The National Academies Press. https://doi.org/10.17226/9728.