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Psychiatry's mission to heal "will not be deterred by the dictates of those who profit from human suffering," declared Herbert S. Sacks, M.D., in his presidential address at the Opening Session of APA's 1998 annual meeting.
Sacks devoted his presidency-and this year's annual meeting-to the theme "New Challenges for Proven Values: Fairness, Decency, Dignity, and Ethics." He selected that theme to recommit psychiatry to its core values at a time when "fairness for our patients, decency, and respect for human dignity have been sullied by corporate organizations driven by profit maximization, aided by weak government regulation."
In a packed hall at the Metro Toronto Convention Centre, Sacks reported that putting the profession's values and ethics first, however, have begun to pay off.
"We have fought back in state legislatures where 30 comprehensive bills have been passed since 1995, and another thousand await consideration. The President's Quality Care Commission has issued a series of recommendations, some of which have been incorporated in planned future Congressional actions. We have supported litigation across America and have been a plaintiff in a major [managed care] class-action suit."
The public, too, is showing signs that it's had enough, said Sacks. The public's anger over managed care has reached a critical threshold leading politicians to identify managed care as a major issue with which to win votes. A recent New York Times article, he said, had reported that candidates for governor and for Congress in about a dozen states are including in their platforms such items as access to more doctors and the right to appeal denied care.
"There has been a striking shift in public sentiment since Mr. Clinton offered his health plan five years ago," Sacks observed.
That shift is related to the phenomenally fast growth of managed care. Enrollment in managed care plans, said Sacks, has climbed from half the workforce four years ago to 85 percent today as employers seek to contain ever-escalating health care costs.
"Millions of Americans are complaining of choices they do not like, and millions have no choices at all. Helen Hunt, playing Carol in the movie 'As Good as It Gets,' slams HMO's with a string of epithets. There is no audience in the nation which has not clapped and cheered in response to Carol's rage."
Ever the independent thinker and passionate respecter of language, Sacks criticized American medicine for passively accepting the language of macroeconomics. "Doctor" and "patient" have been dehumanized into such marketplace terms as client, consumer, customer, and provider.
"Comforting the sick is a core value of our calling. That value is part of our covenant with patients, who must not be damaged in the marketplace by economic forces that have stricken 'caring' from [MCO's] lexicon but not from their logos," Sacks said as the audience applauded.
He lamented the fact that some APA members "spend their energies as foot soldiers in MCO's, many of whom see themselves as economically indentured." They hesitate to take a chance by moving to geographic areas and workplace settings where psychiatrists are in short supply.
Other psychiatrists have themselves become MCO directors-"ideologues disidentified from patient-care imperatives that were overriding at another moment in their professional lives. You and I have an obligation to rekindle in them the candle of compassion and sensitivity to duress."
Moving on to another topic that has consumed most of his professional energy-children-Sacks noted that this most powerless group of Americans continues to be ill served by the current political system. Despite recent legislation to provide health coverage to the 11 million children currently uninsured, only 3.4 million will be affected. Children suffering from behavioral and emotional disorders are being expelled from schools but are not given access to other educational services. Children who commit crimes are increasingly being placed in the adult criminal justice system.
"A nation is measured by how it treats its children, and we, the world's richest society, have failed the test," said Sacks.
Sacks noted that the Senate would soon begin debate on S.10, the Violent and Repeat Juvenile Offender Act. Supporters have failed thus far to bring the bill to the floor because of hard lobbying by APA and other organizations opposed to incarcerating children with adults. He urged APA members at the meeting to go to the booth of APA's Division of Government Relations in the APA Resource Center, where they could send computerized letters to their members of Congress urging them not to support this bill. The other areas that he asked APA members to write about were parity, patient protections, V.A. prescribing constraints, and confidentiality.
"Please, please help our patients, help yourselves, and help the field by taking political action in these five vital sectors," he pleaded.
Observing that candidates for APA office may engage in political hyperbole on which they can't always deliver, Sacks summarized what he believed were some of his accomplishments as APA's top elected leader:
Celebrating the neuroscientific advances that are leading to more effective psychiatric treatment, Sacks commented on Eric Kandel and other researchers whose work is yielding a dynamic theory of human development bridging the psychoanalytic perspective and neural sciences. This line of research suggests that "psychotherapy brings about behavioral change by producing alterations in gene expression, which in turn generates new structural changes in the brain." Biology may not entirely be destiny after all.
"In closing, I express my gratitude to you for honoring me with the most important post in world psychiatry," said Sacks. "I have committed myself fully and indefatigably in serving you with fidelity and in fulfilling your expectations of leadership. My loving family and friends have made possible any successes and achievements which characterized my presidency. My failures belong to me. The presidential honor has capped a career marked by a deep investment in patient care and in advancing the frontiers of our field." -C.F.B.