Tom Ferguson MDWhen I first heard about the People’s Medical Society (PMS), I didn’t know what to think. I’d long felt that a national organization of health consumers was badly needed. Now here was an attempt at one.
The confusing thing was that it was being organized and funded by Robert Rodale. I’d never met Rodale and knew him only as the editor of Prevention magazine and chairman of Rodale Press. I couldn’t help wondering: Was the PMS for real or was it just a Rodale ego trip or a brainchild of the Rodale Press public relations office? I decided to find out.
A little research revealed that the People’s Medical Society is a Pennsylvania nonprofit organization with an eight-member board of directors. That didn’t tell me much. There are nonprofits and nonprofits. If the PMS were a Rodale Press P.R. vehicle, you’d expect the board to be composed of Rodale’s close cronies. This was not the case. One would be hard-pressed to come up with a more distinguished and qualified board:
- Lowell Lenin is a professor at the Yale School of Public Health, an internationally recognized expert on self-care, and one of my mentors. He was one of my teachers at Yale Medical School and has remained a friend (and an advisory editor of MSC) since my med-student days. I can tell you with some authority that he is definitely not someone you’d want to have on a board you intended to be a rubber stamp.
- Patty Phelan is director of San Francisco’s Planetree Health Resource Center, and one of the country’s leading experts on helping laypeople find accurate medical information. She’s a friend as well. MSC donates all its unneeded review copies to Planetree’s consumer health library.
- Lori Andrews is a lawyer, a researcher for the American Bar Foundation, and the country’s leading expert on the legal aspects of self-care. She and I were fellow graduate students at Yale. She worked her way through law school doing freelance newspaper writing. When the first issue of Medical Self-Care came out, back in June, 1976, she was the first journalist to notice, and wrote an enthusiastic and thoughtful story for the New Haven newspaper.
So far, the PMS felt like old home week.
I’d heard of, but never met, the remaining board members: John McKnight, a professor at Northwestern University, a highly esteemed theorist of lay empowerment and a community organizer who specializes in health issues; Harrison Wellford, a distinguished Washington lawyer who specializes in environmental protection; John Fiorello, a health care consultant; R. Barker Russell of the University of Maryland School of Nursing; Belita Cowan, a founder of the National Women’s Health Network; Mark Briklin, the sole Rodale employee, managing editor of Prevention; and Robert Rodale himself.
I was intrigued enough to fly to Pennsylvania, interview Rodale and meet the society’s executive director, Charles Inlander.
The interview in this issue should make it clear that I found Bob Rodale a self-effacing, refreshingly public-spirited health populist and visionary. I asked him how he came up with the idea for the People’s Medical Society.
“At first I found myself thinking of just the name, ‘The People’s Medical Society, ” he explained. “I thought—gee, the doctors have their society, the hospitals and the drug companies have their associations, drug and insurance companies share goals and information, but people go to doctors and hospitals one by one. Wouldn’t it be great if consumers had their own organization?”
An Overwhelming Response. Rodale first wrote about the PMS concept in his June, 1982 Prevention editorial. “The reader response was overwhelming,” he says. “Everyone thought that a consumer health society was a great idea. The people who wrote in expressed a great deal of anger at things like routine waits of an hour or more for a few minutes of testing and talk.
“The response was so favorable I decided to get serious and set up such a group. I got a lot of help and advice in the early stages from Lowell Levin, John Fiorello of The Health Strategy Group, and from Roger Craver and Tom Belford, two of the people who put together the consumer organization Common Cause. Common Cause was in many ways our model for the PMS.
“We decided we wanted to find board members who had a strong sense of the reforms that were needed, and the dedication to work hard. We did not want a bunch of rich people who were never going to do anything but write us an occasional check.”
An Independent Organization. I asked Rodale about the relationship between the society, Rodale Press, and Prevention. “The PMS is a truly autonomous organization,” he assured me. “The board is totally independent. They could vote to kick me out if they wanted to—and with the board members we have, I’m quite sure they’d do exactly that if they thought I was getting off the track.
“Rodale Press loaned the society the money it needed to get started. But it’s all a loan. We fully expect that once the organization gets up and running, it’ll be able to pay it all back.
“Right now the PMS is still pretty dependent on the editorial and advertising support of Prevention magazine and on the use of Prevention’s mailing list, but they’re gradually bringing in more and more members who are not Prevention subscribers.”
A Knocking of Heads. I asked Rodale if he thought there would be conflict between the AUA and the PMS. He nodded sadly. “I hope we’ll soon reach the point where that’s not necessary, but I’m afraid that for now there may be some knocking of heads between doctors and health consumers. People are going to have to start asking for, and in some cases, demanding, what they want.
“It’s the whole purpose of the PMS to make that possible. It’s important that certain people-oriented principles be agreed upon, at a time other than that when one needs illness care. When you’re hurting and worried and sick, that’s not the time to start presenting demands.
The PMS Code of Practice. “That’s why we’ve put so much time and energy into developing the PMS Code of Practice [see sidebar]. PMS members take it to their doctors and ask them to endorse it. We’ll publish a list of all the doctors in the country who do so and make it available to members and non-members alike. So when you go in to see one of those doctors, there should be no further need to discuss these matters.
“The code of practice covers three principles: dislosure, choice, and respect,” Rodale explains. “Disclosure means that patients should have full access to any information they want about test results, medical records, and the doctor’s fees and qualifications. Choice mean that patients are fully informed about all possible options in diagnostic procedures, treatments, and medications. Respect means that patients are treated with courtesy, responsiveness, willingness to explain, and punctuality. We plan eventually to send copies of the code to every physician in the country.”
The West Palm Beach “Action.” Across the street in a small converted house, I found the offices of the People’s Medical Society and spoke with its executive director, Charlie Inlander, a native of Chicago. He told me about the society’s recent “action” in West Palm Beach, Florida.
“It was the first public meeting of PMS members from a local area ” he explained. “Shortly before the meeting we asked all the doctors in the county to sign our Code of Practice.
“The resulting controversy was publicized by a well-planned media blitz which included buying eight hours of air time and sponsoring our own call-in radio talk show. We encouraged people to call up and complain about local medical practices, doctors, and hospitals, and I’ll tell you, we did a land-office business. We also got four feature articles in the Palm Beach Post and extensive media coverage of the two PMS meetings.”
As a PMS Code of Practice practitioner, I will assist you in finding information resources, support groups and health care providers to help you maintain and improve your health. When you seek care for specific
problems, I will abide by the following Code of Practice:
Office Procedures
- Choice in Diagnosis and Treatment
6. I will let you know your prognosis, including whether your condition is terminal or will cause disability or pain, and will explain why I believe further diagnostic activity or treatment is necessary.
7. I will discuss diagnostic, treatment and medication options for your particular problem with you (including the option of no treatment) and describe in understandable terms the risk of each alternative, the chances of success, the possibility of pain, the effect on your functioning, the number of visits each would entail, and the cost of each alternative.
8. I will describe my qualifications to perform the proposed diagnostic measures or treatments.
9. I will let you know of organizations, support groups, and medical and lay publications that can assist you in understanding, monitoring and treating your problem.
10. I will not proceed until you are satisfied that you understand the benefits and risks of each alternative and I have your agreement on a particular course of action.
1. I will post or provide a printed schedule of my fees for office visits, procedures, testing and surgery, and provide itemized bills.
2. I will provide certain hours each week when I will be available for non-emergency telephone consultations.
3. I will schedule appointments to allow the necessary time to see you with minimal waiting. I will promptly return test results to you and phone calls.
4. I will allow and encourage you to bring a friend or relative into the examining room with you.
5. I will facilitate your getting your medical and hospital records, and will provide you with copies of your test results.
“A Roomful of White-Haired People Jumping Up and Down…” PMS Board member Patty Phelan attended the meeting: “I’ve never seen a group of older people more activated and worked up. They were very jazzed that they were going to have a chance to rate their local doctors. We had a whole room full of white-haired people jumping up and down with excitement.
“Bob Rodale is a real hero to these people. They revere him. If that first meeting was any indication, Bob has a very large constituency out there. Some of those who attended have subscribed to Prevention for 20 or 30 years.”
Of the 1200 doctors in West Palm Beach, 47 endorsed the code. True to its word, the PMS published and distributed their names to its local members.
A Sophisticated Media Campaign. I asked Charlie how the PMS had chosen West Palm Beach. His answer made it clear that the organization is making very sophisticated use of the media.
“We were choosing among cities we could afford, those in the 60th to 70th largest media markets: cities like San Jose, Des Moines, Albuquerque, and West Palm Beach. We chose West Palm Beach for a number of reasons:
“The large number of Prevention readers. There were 13,000 subscribers in that one county alone.
“The major Miami media outlets right next door. We knew that spill over into Miami would give us hundreds of thousands of extra listeners and viewers.
“West Palm has enough connection with people from New York that the Eastern media accept it as part of the real world.
“We were testing a number of different pieces that made up the whole campaign: the code of practice, the community response, whether we’d get new members, our radio commercials, our TV spots, our newspaper ads, and our call-in talk show.
“The cost of the whole campaign came to about $75,000. For the same amount of money we could have done a mailing to every physician in the country or bought one spot on New York TV.
“Since the West Palm Beach action we’ve been evaluating the effect of each of those elements on the whole campaign. We’re refining our plan of attack, tinkering with the model a bit. We’ll be using the same general approach in other markets.”
From the Top Down, Then Up Again. I asked Charlie if it wasn’t a bit unusual for a consumer organization to be started by a well-funded national office instead of growing out of a coalition of local grassroots groups. He agreed that it was.
“What we’re trying to do is begin from the top down, then to ignite local activity by providing information, ideas, and expertise for the use of autonomous local groups. We may call a meeting of all the PMS members in a certain area, but we’re not planning to organize local chapters or anything like that. We just want to support whatever they come up with.
“The PMS plans to do three things: support local actions, act as a pro-consumer lobby on health policy, and provide information.”
Supporting Local Actions. “We plan to develop models for several kinds of local actions. We’ll teach local members and groups how to:
“Publicize key statistics on local providers—e.g. the rates of certain surgeries performed at various hospitals, death rates from certain operations, the rate and severity of doctor-caused illness in various facilities, and rates of malpractice clans.
“Identify and root out incompetent physicians.”
“Promote the patient-oriented doctors in the community.”
“Stimulate the establishment of laypeople’s medical libraries modeled after the Planetree Health Resource Center in San Francisco.”
“Analyze the health problems in the community and find ways to prevent them.”
“Encourage prevention through bringing pressure on state and local health bodies, employers, unions, schools, and local media.”
Hospital Evaluation Project. The PMS is now conducting a pilot hospital evaluation program in New York City. The organization has sent forms to more than 5000 physicians, nurses, and PMS members, asking them to evaluate the city’s 78 hospitals.
The group plans to publish the results of those evaluations so that citizens can see how doctors, nurses and other consumers rate each facility.
Physician Evaluation Program. The group has also asked PMS members to evaluate their doctor visits. The results will be entered into a computer, and consumers will be able to request a summary of the evaluations for any physician. The group plans to make public summaries of the evaluations, including average waiting times and the extent to which doctors are encouraging prevention.
Turning On the Lights. Since I got back from my Pennsylvania visit I’ve been talking and thinking a good deal about the People’s Medical Society. It looks very promising. True, it’s fairly new, and many of the ideas are still in the shakedown stage. But the people are first-rate and their accomplishments to date have been impressive.
The PMS is clearly for real. The People’s Medical Society looks as though it may indeed turn out to be the long-awaited organization that gives consumers a voice in health matters and turns on the lights in many of the formerly dark rooms of the medical care system.
RESOURCES
The People’s Medical Society. 14 East Minor St., Emmaus, PA 18049. (215) 967-2136. PMS Information Kit—Free.
List of physiciansin your area who have signed the PMS Code of Practice—Free.
PMS Code of Practice—Free to health professionals who wish to sign it. (Those who do so will be included in a national directory which will be made available to PMS members.)
One-year membership—$l5.00
Elliott Dacher MD
Maryon Stewart
Dr. Judith Orloff MD