He Might Have the Cure for Medicine’s Ills

It is oddly reassuring to spend time with Dr. Lonnie Bristow, small-town doctor and newly elected president of the American Medical Assn.--the first black president in the AMA’s 148-year history.

During those moments, you bathe in the aura of a kindly, assertive man who believes that the current crisis in American medicine is not a fatal condition, and that in his new capacity he can help to make it better.

If Bristow can be believed--and he admits it might require a leap of faith for some familiar with AMA history--the way to start curing medicine’s ills is for doctors to rejoin the organization that a majority of them have abandoned in recent years. Only 40% of U.S. doctors now belong to the AMA, down from 70% two decades ago.

We are in an era when doctors are losing control of the care of their patients, Bristow says; when patients sense that the quality of care is diminishing; when some of the country’s great medical institutions are endangered because of lack of funds and drastic cutbacks.

“We now have health care being controlled by MBAs rather than by physicians committed to the Hippocratic oath,” Bristow says, referring to the corporations from which most Americans receive health insurance. “And once health care becomes corporatized, as it has, and once it goes on the open stock market, then its major commitment is to Wall Street and the stockholders to maximize profits, rather than to give the best possible patient care. Business principles are introduced that unfortunately put patient care second to corporate profits.”

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It is an uncharacteristically direct outburst for Bristow, 65, who has worked his way up through the ranks of the AMA, who appears to be the consummate organization man, and who speaks sincerely but cautiously during an interview.

His discretion has apparently been honed to a fine point during 30 years of participation in the AMA, considered by many to have been a racist organization.

For much of the AMA’s history, black doctors were not allowed to join. Until 1968, the organization permitted state and local branches to deny membership to black doctors simply because they were black.

The AMA also backed South Africa’s medical society in international medical meetings, although the group supported apartheid until 1989.

Bristow, who has practiced internal medicine for 30 years in San Pablo, Calif., speaks in a soft voice unmarked by anger or agitation.

He acknowledges that when he joined the organization in 1958, after finishing his internship at San Francisco City and County Hospital, “There were parts of the country where black Americans could not join.” But in San Francisco, he says, “There was nothing to it.”

His philosophy regarding many tough issues, including racism, he says, “is that if you want to change something, you do it from the inside. You don’t stand outside and complain about it.”

He applies that reasoning to doctors who have broken away from what Bristow calls “the mother group,” preferring to belong only to associations related to their own medical specialties. Cardiologists, radiologists, urologists and others have begun to think of themselves as specialists above all else, Bristow says.

Many have splintered into even smaller subgroups, he says, preferring to associate with those who are like them in the sense that they support or oppose abortion rights, are Republican or Democratic, are fee-for-service or salaried.

Bristow’s goal as president will be to “make all these doctors understand that we have much more to unify us than to divide us. What we have in common is much more meaningful than that which might pull us apart.”

If the defecting doctors can be persuaded to “come back under the umbrella of the AMA,” he believes, “we will have more leverage and a better chance to get the kind of medical care for our patients that most of us want.

“The entire profession of medicine, and the doctor-patient relationship we all respect and love, has sailed into harm’s way,” he says. “We have to pull together the way any family would in a time of trouble,” to get medicine back on the right track.

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Bristow, a tall, imposing figure in a charcoal gray suit, stops to ponder for a moment.

“It’s hard for me to explain just how exhilarating and personally satisfying it is to make an impact on another human being’s life in a positive way. Doctors share that, above all else. It is the reason we became doctors in the first place.

“That ability to make an impact, to help improve patients’ lives” is being eroded by corporatized health care that is not run by doctors but by business people and that dictates what treatment, and how much treatment, doctors can prescribe, Bristow says. “It intimidates doctors into acquiescing,” he says.

“That is a major reason for doctors to band together, no matter what their specialties or political beliefs.

“I don’t expect all doctors to agree on everything. But on certain key issues, such as the sanctity of the doctor-patient relationship, the importance of freedom to choose which doctor to see, the importance of physicians being able to practice medicine the way they think is appropriate--those are issues which all doctors should be able to rally around.”

He says the AMA will support a Patient Protection Act in Congress at the end of summer. It would guarantee, he says, full disclosure about all insurance programs, so potential subscribers will know the program’s track record, whether previous users have been satisfied, and how much of the premium they pay actually is spent on patient care as opposed to dividends to stockholders and salaries for corporate managers.

The act would also mandate that physicians who contract with an insurance program may “not be fired without cause and without due process.” Physicians are being threatened by insurance companies who vow to fire them from the group if they do not practice medicine the way the insurance company directs them to, Bristow says.

The AMA, he says, is working to get universal health-care coverage, to make health care portable, and to make it available to people with pre-existing conditions.

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Bristow was born in Harlem, N.Y., to a Baptist minister father and a mother who was a nurse at nearby Sydenham hospital.

His interest in medicine began, he says, when as a boy he would go to the hospital emergency room to pick up his mother and accompany her on the walk home. There were medical workers of all races pulling together there, he recalls, and they were saving people’s lives.

Bristow received his bachelor’s degree from City College in New York in 1953, and his medical degree from the New York University College of Medicine in 1957.

He went to Northern California for his internship and residency, and has specialized in occupational health there since.

He began cutting back on his practice a few years ago, he says, as he became more involved in organizational work and travels on behalf of the AMA.

“As a physician, I was helping one person at a time. It became evident that if I really wanted to improve medical care for my patients, for my community, perhaps even for the whole country, I would have to have some sort of advantage, some greater power than I had as one lone doctor. That’s what organized medicine provides.”

He became the AMA’s first black member of the Board of Trustees in 1985, and the first black chairman of the board in 1993. He spent about half of last year on AMA business, for which he reportedly received $278,000 in compensation.

Bristow and his wife, Marilyn (a former nurse who has been his office manager for 30 years), were in Los Angeles recently to help their son, Robert, settle into a Westwood apartment. He is an obstetrician/gynecologist starting a fellowship at UCLA in gynecologic oncology.

Their daughter, Lisa, runs a day-care center in Northern California.

Bristow says he hopes to “get away from the stereotypes” once associated with the group over which he now presides. He would like the nation’s doctors as well as the general public to come to think of it as “our AMA,” meaning that it’s a group that has the public’s health as its major concern, and that it “takes good care of America.”