Commentary

Doctor-Workers: Unite!

Could Disobedience Be the Path Ahead?

Howard Waitzkin, MD, PhD

Disclosures

May 20, 2016

In This Article

Redemption

As a doctor-worker, I faced a challenging ethical situation that included loss of professional autonomy, authoritarian practices in the workplace, and apparent abandonment of patients. My first suspension in more than 40 years of practice also raised concerns, such as: Would a report about the suspension from OHN to the National Practitioner Data Bank affect my medical licenses or ability to practice in other settings? Was it my responsibility to blow the whistle on OHN's practices to licensing, accreditation, and insurance agencies?

My small act of conscientious disobedience eventually led to some unexpected responses. My contract and state law required that OHN convene an external review to examine possible interference with my professional judgment, and the coordinator of the state agency that licenses health facilities expressed willingness to investigate this issue and the abandonment of patients.

Facing the probability of external review, the CEO finally met with me in person, and I proposed a formal mediation process. Instead, the CEO composed a document that included an apology, a statement that information about breach of contract would be removed from my personnel file, a commitment to consider individual physicians' preferences in meeting future training requirements, and a promise to meet individually with a physician when a suspension is considered so that patient care would not be disrupted.

Where is the path toward a noncorporatized vision of what we know medicine can be at its best? I don't think that path involves our continuing acquiescence. I confess that I have decided to approach these problems through personal acts of disobedience. For a person like me, closer to the end of my medical career than the beginning, such acts don't risk much. For others, overcoming the risk will require a more organized approach to disobedience.[8] Dare I encourage disobedience in unison? To paraphrase someone else: Doctor-workers of the world, unite!

Table. Resources for Organizing Among Doctor-Workers

Author's note: This list is preliminary. Major professional organizations are not included at this time because of my opinion that they have not taken a lead in organizing and representing doctors-workers. I welcome comments

National Organizations:

Physicians for a National Health Program

National Physicians Alliance

Service Employees International Union (SEIU)

SEIU Committee of Interns and Residents

American Federation of State, County and Municipal Employees

American Federation of Teachers (AFT) Nurses and Health Professionals

Union of American Physicians and Dentists

Other Resources:

Oregon Healthcare Organizing Project

Moving Forward From the Affordable Care Act to a Single-Payer System

 

Supplementary Material

"eDocuments of Disobedience," available on request, includes memoranda intended as illustrations for doctor-workers to use when contemplating or executing acts of disobedience.

Acknowledgments: I am deeply indebted to my deceased friend, Mark Teismann, PhD, who provided inspiration, encouragement, and critical feedback for me as I wrote this article while he was dying; and to my partner and co-conspirator, MiRa Lee, MD, who offered constructive suggestions and reminders that disobedience can transform the world.

What Do You Think?

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