Itchin' for a Fight


A search for rabble-rousers

In the tradition of Patrick Henry, the great pamphleteer and rabble rouser of the American Revolution, Todd West and Patrick Conrad, family physicians and friends from residency, brought a manifesto -- and hope for change -- to the annual meeting of the American Academy of Family Physicians in October.

Their pamphlet, which they distributed throughout the exhibit hall, protested federal control of medicine, offered West's cash-only clinic as a new model, quoted from objectivist philosopher Ayn Rand, and invited conversation on the future of American medicine. For good measure, they wore T-shirts featuring an over-the-top stick figure caricature by Conrad showing a physician getting spanked by Uncle Sam.

As Conrad says, "There are some inexorable trends in medicine ... that are rapidly denigrating the primacy of the individual in medicine."

"We just wanted to stimulate conversation ... to see what other people's thoughts are about how things are going," West explains. "We're just astonished about the profession and where it is now compared to where it was 10 years ago when we were making the decision to become doctors."

Did their frustrated family practice colleagues commiserate? Offer their own strategies for getting by? Hold an impromptu mass protest?


"We got absolutely no interest from anybody," West reports. "No e-mails, no curious looks, no smiles, only a few smirks and frowns. ... When we were walking through the exhibit hall, practically every physician we passed looked like someone had just come up to them and slapped them very hard, then walked away with no explanation."

West attributes the reaction (or lack of) to exhaustion. "They are just tired, wiped out. So worn out by the day-to-day routine of trying to keep their heads above water that they don't have the energy to think about how they can change how they interact with insurance companies and federal regulations.

"I think they are just so beaten down that they don't have a sense of humor anymore," he adds. "They can't find the ability to laugh at what has become just an absurd situation in medicine. ... I think [laughter] is a healthier response compared to what I see among my colleagues. They just kind of stare with a blank look on their face."

Now, it might be that West and Conrad's approach was a bit too much or a bit too conservative. Ayn Rand?

Or maybe it takes more than 500 flyers and a couple of T-shirts to break through the clutter of a big exhibit hall.

Still, I'm surprised that no one so much as asked for a free T-shirt.

Every day I write about how fed up physicians are. I get e-mails from physicians' spouses, worried about being able to afford braces for their kids. I get calls from reporters wondering why physicians are dropping Medicare. I read the surveys. I get feedback to these columns. I know the pain is bad.

So why isn't anyone kicking back -- even with something as small as a slap on the back for a couple of agitators?

Where have all the rabble-rousers gone?

Give me your explanation. Write to me at

Pamela Moore is senior editor at Physicians Practice.

This article originally appeared in the January 2004 issue of Physicians Practice.


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