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Keynote speech: Medicine's response to the events of Sept. 11

Copyright 2002 by the American College of Physicians-American Society of Internal Medicine.

By Phyllis Maguire

Has the medical profession changed in the wake of the Sept. 11 attacks? Walter J. McDonald, FACP, the College's Executive Vice President and Chief Executive Officer, posed that question to Annual Session attendees during his keynote speech at the Annual Session Opening Ceremony on April 11.

Many things have certainly changed for physicians—and all Americans—since the attacks, Dr. McDonald said. "We are all less wide-eyed, we take less for granted and we spend more time with our families," he noted. "We also realize that we can't remain isolated from the rest of the world, but we must work with other peoples and nations."

The medical profession, however, has also faced several specific threats to individual and collective health and safety. Physicians have had to mobilize not only to learn how to recognize and treat bioterrorism agents, but also to play a key role in educating patients and the public.

As Dr. McDonald explained, the College and other organizations have come forward to meet the increased demands for information from physicians and the public by greatly expanding Web-based resources. While the College established its online Bioterrorism Resource Center well before the Sept. 11 attacks, it has been regularly adding material to the site. (The center is online at www.acponline.org/bioterro/index.html.)

But physicians need to do much more to counter safety threats, Dr. McDonald continued. They need to sustain their call for more resources to reinvigorate a strapped public health system, and they must continue working on emergency planning within their communities.

In addition, physicians must maintain an interdisciplinary dialogue to deal with the attacks' fallout on patients' mental health. "Already," Dr. McDonald said, "there is evidence of event-related increases in post-traumatic stress disorder, depression, alcoholism and family stress."

Physicians must also confront financial problems made worse by the attacks. Rising unemployment will cause some patients to lose coverage or income, which will affect their ability to get health care. As physicians continue to cope with more acute access problems in their communities, the profession must renew its commitment to advocating for universal coverage.

At the same time, Dr. McDonald said, medicine's political agenda has been severely threatened since the events of Sept. 11. Just two years ago, budget surpluses made reforms like the patients' bill of rights and prescription drug benefits seem possible. Now the country's domestic agenda has been drastically curtailed, while foreign policy has been expanded and re-focused.

While the profession must continue to advocate for changes in health care delivery here at home, Dr. McDonald added, physicians must take a broader view. They can seek opportunities to help craft foreign policies that address the health care disparities that accompany poverty and help breed terrorism.

Finally, while the profession has faced unprecedented challenges, Dr. McDonald noted that there has been some good news: Medicine's core professional principles—the primacy of patient welfare, the importance of patient autonomy and the need for social justice—have stood firm.

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