A Clinician’s Approach to Fixing Health Care
By Will Nicholson, M.D.
While the national debate about health care reform seems to become more abstract and outlandish every day, the realities of our broken system are ever more immediate. I recently received a flyer announcing a fundraiser to help a local physician pay his medical bills. It reminded me that in a health care system as dysfunctional as ours, even physicians are not safe from catastrophy.
It is disappointing that in our current attempt to overhaul the health care system the insurance industry, drug companies, and political partisans have taken center stage while those of us working on the front lines with patients have been largely left on the sidelines. Understandably, many physicians avoid politics altogether because of the dishonesty, shady tricks, and winner-takes-all tactics used by the various players. It is a risky proposition to wear a white coat into a room full of mud-slingers.
Although wading into the morass of American political discourse is daunting, actually taking some first steps need not be that difficult. For one thing, we don’t need to take those steps alone. We physicians need to approach the challenge of fixing the dysfunction in the health care system the same way that we approach treating disease—by collaborating, working as a team, and applying our professional standards to the process.
Working as a team is as important to influencing health care reform as it is to caring for patients. Just as organizing as a practice group allows individual physicians to reclaim power over their weekly routine, organizing as a profession gives individual physicians more power over their future. And as with sharing call duty, if each of us contributes, the result is better for everyone.
One of the most convenient ways physicians can do this is through our existing professional organizations. Yet only about 20 percent of physicians belong to our biggest and oldest professional organization, the American Medical Association (AMA). This is clearly not enough to give physicians the upper hand in the health care reform debates.
Working as a group can be cumbersome. Many physicians are reluctant to participate in organized medicine because of differences of opinion within others in the group. As professionals, we need to realize that even though we may disagree with one another on certain issues, we have more in common with our fellow physicians than we do with the other interest groups vying for control of health care. We need to make participation in our professional associations a priority.
When physicians are not involved in organized medicine, a minority may misrepresent the majority opinion. For example, a recent nationwide poll of physicians published in The New England Journal of Medicine found that a solid majority, 73 percent, of physicians supported some form of public option for medical insurance. Yet it was only very recently that the AMA shifted its policy in that direction. Regardless of how you feel about a public option, you can see that when only a handful of physicians are making the calls, the interests of the majority may not be served. The public is hungry for our input, and we must represent our profession accurately.
To make sure that happens, we physicians need to do politically what we do as clinicians. When it comes to patient care, physicians are great at interspecialty collaboration. We keep the greater goal—helping the patient—ahead of individual disagreements. Unfortunately, we have often let turf disputes get in the way of the best interest of the profession as a whole when it comes to our professional organizations.
As an example, I was stunned when a lobbyist representing emergency physicians at the Republican National Convention last year told me that reducing health care costs by stemming the flood of nonacute, nonreimbursed care into ERs was not in the interest of emergency physicians. His response was, “If you [a family physician] think you’re going to take away 12 percent of our ER patient population, you’re crazy.” From his point of view, he was advocating for his constituents. I met other lobbyists from other medical specialties—including my own—who were not much more enlightened about the importance of taking a team approach to problem-solving, an approach the physicians they represent depend on every day.
In contrast, the well-funded lobbyists who represent health insurance and pharmaceutical companies have agreed to team up to advocate for the greater causes of their respective industries. Even as the organizations they work for battle each other mercilessly for market share on a daily basis, they have cooperated on national health care policy, and their impact is undeniable. If physicians could somehow speak with a single voice about health care reform, we would have unparalleled influence.
In order to speak with unity, we need to find principles about which all specialists can agree. We all believe that science is the basis of our practice, we’re committed to the patient’s welfare, and we value the ethical and professional codes of conduct that guide our patient interactions. As we become more politically engaged, we need to unite around the same principles that guide us in our practice every day.
The training, background, and instincts that help us care for ailing patients in our daily practice need to be applied on a larger scale as our nation attempts to care for its ailing health care system. Although it may not seem like the most natural extension of our scope-of-practice, getting involved in this political debate is necessary. We can start by working together as a profession, collaborating with other specialists, and setting the bar high for ethics and professional standards. With so many standing in the way of effective health care reform, it’s time for physicians to take these simple steps and get things moving in the right direction.
Will Nicholson is a family physician who practices at St. John’s Hospital in Maplewood. He blogs about health care issues and his experience as a health insurance consumer at www.triagepolitics.com.