I recently watched the classic Western movie High Noon (1952). Despite my love for movies and an extensive collection, this was the first time that I had seen this particular film. It is amazing, and sometimes creepy, how the same themes repeat themselves throughout history, and how well old stories relate to current events.
For anyone who does not know the story, in the movie the protagonist, Will Kane, portrayed by Gary Cooper, is the retiring marshal in the small town of Hadleyville located in the New Mexico territory. He has just married Amy (Grace Kelly), a pacifist Quaker, and is on his way out of town with his new bride when he gets word that a criminal he worked hard to put away, Frank Miller, has been freed on a technicality and is on his way back to town. Kane knows that Miller will terrorize the town and will likely come after him, as he had previously threatened to do. Feeling the duty of his position despite just retiring, Kane returns to the town to face Miller.
Kane seeks to put together a posse to stop Miller and his gang, but it quickly becomes apparent this will not be easy. He’s been a tough marshal and has made as many enemies as friends in the town. His old deputy Pell (Lloyd Bridges), who Kane did not think was ready to be the new marshal, tries to bribe Kane into giving him the marshal position. When Kane refuses, he quits in anger. The people in the saloon want nothing to do with him. The innkeeper is cheering against him. His previous allies are scared of Miller and fear for their lives. His friend Sam Fuller (Harry Morgan) pretends that he is not home and sends his wife to the door to lie to Kane, saying he is not there. The previous marshal says he is too old to fight and has arthritis. The people in the church think if Kane will just leave town, the problem may simmer down and somehow go away. The pastor claims piety and sets himself above the fray, saying he condemns all violence, although it is clear he knows Kane is right.
All this time the clock is ticking towards noon. The train-whistle blows as Miller arrives and comes with his gang into town. Kane is left to fight by himself. He kills several gang members before being wounded himself. His new wife, who had been planning to leave on the train, runs back to find him and despite her pacifism, shoots another gang member. Miller takes her hostage, but she distracts him long enough for Kane to shoot him dead.
Finally the townspeople come out to find the gang and Miller dead. Kane throws his badge in the dirt and leaves with Amy as the credits roll.
So what does all of this have to do with our situation today? The parallels are obvious, if you choose to see them. Doctors are the townspeople. The ABIM/ABMS represent Frank Miller and the gang who have taken advantage of the townspeople (MOC). There are a few ‘Will Kanes’ out there like Wes Fisher who have taken a stand against the criminal wrong.
The question is who are you? Are you one of the people in the saloon who are siding with Miller’s gang? Are you a churchgoer who just wants Kane to go away and is hoping that Miller won’t continue to take advantage of the town? Are you the pastor who views himself above the fight and wants to pretend that he can go on doing his job while ignoring the wrong he sees? You can be Sam Fuller, Harvey Pell, or any of the others who run from the fight.
Or are you Gary Cooper, who despite all of the odds and the forces against him, knows right from wrong and is willing to face the bad guys?
Your choice.
Great post, another movie added to my iTunes queue to watch with the kids! Gotta wonder what the bosses at the ABMS and subspeciality boards see when they watch movies like this.
I am and have been Will Kane for 25 years. You are just hitting the tip of the iceberg. Have you checked out the new central credentialing for Interstate licensure? This all began when balance billing was disallowed for Medicare and private managed-care followed suit with imponderable contracts that were driven by physicians fear that they would no longer be able to see patients who would be denied access to the practices. I am from St. Paul Minnesota and has served as a trustee on March systems all the while practicing internal medicine. I left the “grid” in 2001 and went direct pay or cash. I dropped all of my ACP, AMA, et cetera affiliations quickly.
I love your website and re did often. This was excellent. I have drawn myself to similar metaphorical books, movies, music, art, et cetera often as Camus (who wrote the original book, “The Rebel”) said that the Rebel is the individual who “holds history together between the extremes of the ‘all or nothings'”.
Chris Foley M.D.
Good for you, Dr Foley and good for you, Dr Nielsen! I love Dr. Edison’s posts! I’m amazed to reflect that despite 40 years of full-time practice in busy urban, suburban, and rural hospitals, despite being a “Lifetime Fellow” of my college, despite maintaining a faculty appointment at a prestigious west coast University and despite successfully “recertifying” my prowess as a specialist in my chosen specialty 3 times, my Board’s opinion of my worthiness to continue in practice as a certified specialist depends upon the timely completion of multiple increasingly silly little activities that someone with nothing better to do must have thought up on a lazy Saturday morning while watching cartoons or maybe Saturday night while watching SNL!
Excellent analogy, Dr Nielsen, between the ABMS-MOC testing industry and the villain attacking town in the movie High Noon. Doctors (and our patients) have been hurt by MOC since 1990 because we have maladaptive behaviors allowing such bullying and exploitation to proceed unchecked. Doctors 4 Patient Care radio show host ENT surgeon Mike Koriwchak, MD, offered a profound analysis of maladaptive behaviors among ourselves when discussing his meeting with CMS and IT vendors in April, 2016 (The Doctors Lounge 4/14/2016). “Doctors are pleasers.” We please authority figures our entire lives, first parents, then teachers, professors, then attendings, and now health care regulators. We’ve paid huge fees to organizations not representing patient interests or the needs of our profession. SUCH PLEASING BEHAVIOR MAKES US SITTING DUCKS. It is maladaptive in the business world when facing regulators, hospitals, or others with alternative interests against patients and against ourselves. Fortunately, some within CMS and the IT industry recognize the morass in malignant data reporting requirements. They might be interested in evolutionary changes trying to restore functionality to US healthcare. Unlike CMS, I am afraid that ABMS, like the villains in HIGH NOON, even after lame apologies in 2015 remains incorrigible. ABMS program executives are marketing their un-validated, unmerited MOC programs now onto aging physicians (>60 years of age, “graying physicians”, JAMA Jan 2016) in addition to the Federation of State Medical Boards and its Interstate Medical Licensure Compact Commission (which violates state medical board hegemony). ABMS almost hijacked the Institute of Medicine 2015 initiatives on improved patient safety and bedside diagnostics. They duplicated the IOM report with their own Dec 7, 2015, ABMS Summit on Diagnostics and Certifications in Chicago. Among Specialty Board take-home bullets from the ABMS-funded self-promotional symposium, published shamefully at taxpayer expense by the National Academies, ABMS quotes in large type one of their palliative care-public policy Board members as an authoritative spokesperson recommending MOC exams for all physicians. For this occasion, MOC was recommended as a measure of professional competence and dedication to improved diagnostics. The spokesperson sees no patients and does not take night call. She was not even a nurse or physician but rather an economist (London School of Economics) and popular book author. Her only medical background consisted of several years volunteer work at a free medical clinic in the Washington DC area. After 20 years of flawed MOC operations and marketing like this, it is time to bury MOC as decisively as our hero in the movie buried the village bully. We need to act w organized medicine, our universities, specialty societies, our legislators, the courts, and perhaps the Federal Trade Commission against MOC malfeasance in order to save US medicine and our patients.
Great analysis, Dr. Leisure. Where do I join?
A lot of Will Kanes needed pronto.
Five stars for these lawmen fighting the MOC extortion mafia!
Here’s another analogy: Godfather 2. Young Vito Corleone (played by DeNiro) witnesses Don Fanucci, the “Black Hand” extortionist of Hell’s Kitchen knifed by a group of young thugs who don’t buy into his reputation of invincibility. The blowhard Fanucci finds out that Corleone, Tessio and Clemenza are stealing garments and demands “respect” from the youngsters who should allow him to “wet his beak”. Tessio and Clemenza fear Fanucci and his connections, but Corleone refuses to be extorted, and finishes off Fanucci with extreme prejudice. He becomes a man of respect himself for having the stones not to believe the hype.
Ironically, their rhetoric is right out of Godfather 1 psychology. Vito understands that the best way to make an effective threat is to dress it up in civility and reason. The stated message is “doctors should strive for lifelong learning” but of course no reasonable person argues with that. The real message is “nice practice, would be a shame if anything happened to it.”
White collar MOC mafiosos have no place in medicine and these people are only powerful if we grant them that respect they do not deserve, much like cowardly merchants did with Don Fanucci. Oklahoma just stabbed the arrogant Don, and now we must realize he is a paper tiger and finish him off.
I realize that pharmaceutical representatives do not visit us anymore, but what has replaced that is worse than those free educational lunch and dinner meetings. That is the ENORMOUS AMOUNT of money now being spent on television ads asking our patents to ask we PCPs for information and should they be tried on drugs that have multiple potential side effects and frequently not covered by insurance.
One MD I worked with briefly thought he had the solution–he had an audiovisual break room, and offered elective CME to us and other practicing friends during an hour lunch. Someone maybe should bring up a concept of a percent of EVERY COMMERCIAL FUNDING, include funding local certified and reviewed lunch and dinner talks.