Shhh

In discussions about the evils of doctors, one of which I guess I still am, one frequently hears talk of "the conspiracy of silence." Doctors, we are told, are part of some sort of grand and nefarious cabal which has pledged never to criticize one of their own. I'm not sure when I was supposed to receive the order and sign the pledge, but I must have missed it. Or maybe I was also programmed to not remember.

Since, as will become evident in a moment, it's not really the point of this post (would have been a good one for my Surgeonsblog), I won't dwell on it; but I will say there are situations that can be uncomfortable. For example, it wasn't rare that I saw a patient who'd been given what I thought was improper or questionable care by another doctor. What to say to the patient about it, and whether and how to express my concerns to the original physician are not easy questions, for a number of good and bad reasons. But, for the purposes of this discussion, let's agree that nearly everyone -- especially non-doctors -- find the tendency to hold one's tongue in such situations abhorrent. Dishonest, maybe. Conspiratorial, and dangerous. (As a general principle, I can't disagree; but, largely because in medicine there aren't always clear-cut answers, in practice it's not always as black and white as it might seem.)

And that brings us to my point. Along with several commenters on this blog, and various pundits and screamers, Jeb Bush doesn't like Barack Obama pointing out that things were pretty bad when he took over from Brother George. Funny, isn't it? What's good for the goose isn't good for the goosed.

First of all, it's not as if blaming one's predecessor (assuming he's from the opposite party) isn't traditional. When G W Bush came into office he set about reversing just about everything Clinton had done. Rather than thinking up things on his own, he appeared simply to look at Clinton's policies, decide what would be a 180º turn, and do it. In the case of Barack Obama, it really IS different: he really DID inherit a huge mess. By anything standard claiming touch with reality, it's undeniable. So what would be the argument for staying silent about it? Professional courtesy?

Jeb frames it in terms of Obama "trying to make himself look good." Well, I suppose there's some of that. In the medical context, I'd rather not take the blame for a bad outcome if what I was trying to do was salvage the wreckage of a previous surgeon. (In fact, the first time I was sued -- as mentioned in my book -- was after the death of a patient horribly botched and then transferred to my care when I was in training. I practically lived by her bedside as we tried everything, in vain, to save her; the summons was a shock and an eye-opener, and even though I was rapidly dropped out of the case, it left a horrible impression.) More important, though, is the need to make clear what was done wrong so it doesn't happen again. Maybe, too, it's helpful to engender confidence in the new plan by clearly stating how it differs, and why, from the old one. Not to mention why such drastic action is necessary.

Only the most blindly partisan and unbalanced could claim the US was not in crisis when Barack Obama took over. Unsurprisingly, the head of the RNC is among those who think everything is just ducky, while Congressional Republicans propose only more of what got us here. It would seem, in other words, that reminding people of why things are the way they are is more than politics. It's imperative. Because as far as the opposition is concerned -- refining the definition of insanity -- all we need is to keep doing what we did and things will get better.

In a rational world, one in which politicians were capable of thought and collaboration, where people who disagree with each other were able to find ways to some sort of middle ground, I might join those who call for focus only on plans and not the past. Reminding everyone of the mess the previous administration caused could become tiresome, in a land free of denial. But that world most clearly no longer exists, if it ever did. Against the tide of distortions and erased memory that flows from the other side, a little reminder of the truth now and then seems like smart policy.
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