Asking Questions (in Medicine) is Getting Dangerous

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Asking Questions is Getting Dangerous

I write for several publications and I’m always pitching to new venues.  Recently I pitched an idea to an editor.  I wanted to write about gun research from the perspective of a rural physician. In particular, I wanted to ask what might physicians say if researchers found answers that were uncomfortable.  What if they found that intact families, strong fathers, religious engagement or familiarity with guns were factors that reduce violence?  Would the house of medicine accept that?  Or does it want research in order to say ‘here’s why we must ban guns?’

The editor in question was kind but declined.  In fact, he said ‘I want to keep my job.’  I respect him.  I have no interest in causing him any sort of discomfort.  However, the point was telling.  Once a narrative is established, it cannot be questioned without danger. And this is nowhere more true now than in the house of medicine.

For instance, a physician treads on perilously thin ice if he (or she) suggests that perhaps the wage gap in medicine is more a function of hours worked or specialty chosen than of gender discrimination.  Even though this seems to be the case in much of the research on wage disparity.  Women and men choose different careers and work in different ways.  It has nothing to do with the fact that women shouldn’t do a particular job, or men should. And nothing to do with their work ethics, or the quality of the work that they do.  Certainly to the extent that a woman or man do the same work, they should be paid the same.  And no question about it.

Moving on, a physician may be in deep trouble for asking about the wisdom of replacing physicians with nurse practioners and physician assistants. This trend has been gaining momentum for years and while I have worked with excellent clinicians from both types of training programs, I still maintain that they are not physicians.  And this is true especially when they are recently graduated, and/or from online programs.  It is considered unkind to say things like ‘I didn’t do my residency online.’  In point of fact, I have learned of physicians fired, or threatened with firing, for simply making such allegations.  And yet, if we can’t ask the question, we can never know the truth.  True comparisons may reveal that we should change our entire approach to medical education and make it shorter and more focused!  But if we can’t ask, and ask honestly, we’ll never know.

I could go on.  I’m confident that you, dear reader, if you value truth and inquiry, have a few things you’d like to ask. And yet, you know better. The thought police have done a wonderful, thorough and monstrous job of suppressing dissent today.  Germans feared the Gestapo and Russians the NKVD; and we’re not there, to be sure.  Dissent in those regimes often meant torture or death.  But how far is it from ‘you can’t say that or I’ll ruin your career?’ to ‘I heard you said that; get in the car.  We have questions for you.’

Is this hyperbole?  I don’t think so.  For a very long time we were told that religious believers were the impediments to science and progress. That hasn’t been true in the West for a very long time.  Now it’s social justice, political correctness, the great leveling wherein everyone has to be exactly equal on every point.  The great purge, the great Witch Hunt, wherein anyone who acts differently, looks different or (Science forbid) thinks differently, must be hauled out before the tribunal for repentence and penance or punishment.

Ironically, modern academia (with the force of government, the refuge of the courts and the theater of the media) may be the greatest impediment ever to the growth of knowledge and pursuit of truth.

And medicine, my beloved medicine, is among the worst of all offenders.