“We Have No Choice”


Leonard Zwelling


         In her piece about Donald Trump’s reaction to the Orlando nightclub
shootings, Amy Davidson discusses the presumptive GOP nominee’s repeated use of
this phrase to justify some outlandish proposal he is making. Whether it is the
Wall between us and Mexico, the religious test for entry into the US or his extreme
views on immigration, Mr. Trump rationalizes his ideas because, after all, “we
have no choice.”

         But we do, thank goodness.

         I fully understand those who cannot abide by the notion that
Hillary Clinton will be the President. She is of dubious character and is as
responsible as anyone for the dismal state of America’s opinion of its own
politicians. But she’s not nuts! Mr. Trump’s ideas, regardless of the state of
his psyche, are nuts and more importantly un-American.

         This idea of having no choice is fallacious. Of course we
have a choice. We can choose between Hillary Clinton a truly gifted, bright,
but ethically challenged adult or a petulant five-year old in the midst of
having a tantrum about his golf course. This is an easy choice. It is not a
pleasant one, but one of the characteristics of being an adult is having to
make choices between two options that are both unpleasant. In other words, suck
it up America and pull the lever for Hillary. I will and I don’t want to
either, but that’s the choice before me, so I will do what I have to regardless
of being reluctant to do so.

         Now to point two.

         The same is true in the halls of academia.

         If you do not ascribe to the conflicted interests of the
current leadership of most academic medical centers, for goodness sake, say so.
If you think the encroachment on tenure is wrong, say so. If you think the grab
for more and more clinical revenue on top of the imposition of useless
electronic medical records is just a hare brained idea whose time was never here,
say so. And if you really don’t believe that the genomic analysis of human
cancers will give way to a personalized form of pharmacologic therapy, say so.
Finally, if you really do not think that the green eyeshade crowd ought to be
telling doctors how to practice medicine, say so.

         Speak up. You see something; say something.

         Donald Trump’s pet phrase is no more true in the way he
applies it than the use of similar language is when applied to the current
state of academic medicine. We do have a choice. We can opt for quality care
over volume. We can specialize in patients who the faculty can uniquely help or
who can uniquely help the faculty answer important research questions and send
the other patients (and the thousands of infrastructure jobs swelling the cost
side of the ledger) elsewhere. These are all choices. Unfortunately, the
faculty is not involved in making these choices and that’s a shame. If you believe
that shared governance is really in effect anywhere, I would like you to tell
me about it: leonard.zwelling@gmail.com.
My sources tell me that the situation at Anderson is typical not unique at all.

         In fact, that just about sums it up.

         The Brexit vote is like the nomination of Trump. People were
given a choice and they made the wrong one because they were so disgusted with
what they had they would try anything else. We will see very shortly how that
works out in the UK, but it ought to be a warning sign to Hillary.

         If America feels the way the Brits do about their
government, Mr. Trump may well be the choice. But let’s be clear, just like the
British, we do have one.

Leonard Zwelling