by Ernesto Gutierrez, MD
There is a lot of discussion about what Obama did right and wrong in managing the politics of passing health insurance reform. What strikes me as the most obvious is the failure to engage physicians. Sure there was support from the AMA, ACP, and AAFP, but the support was lukewarm at best. The position letters sent out to society members outlining their support seemed forced and mandatory. Physicians were simply not moved to voice their support.
Health care insurance reform, as envisioned by Obama, does nothing to help strengthen the physician-patient relationship that is crucial for managing disease. The failure to understand that the fear of malpractice, in addition to the financial pressures from third party payers (that in other circumstances would not be tolerated if it were not for the fact that physicians cannot organize into unions and negotiate as a class), drives a culture of medicine that finds it too easy to order more labs, studies, and consults, makes it difficult to practice medicine as we were taught in medical school, and leads to scores of unsatisfied physicians and patients is a monumental failure of a president eager to establish his role as a positive force in American history.
Many physicians witness a friend or colleague who is taken through the legal system’s method of using litigation to reach justice, and they see how easy it is to for a physician think of a challenging patient as a liability rather than as a suffering human being. Why not cover your ass, send them along, order the pan-CT, pan-consult again? It’s much easier than sitting down, listening again, re-examining what you have, or explaining again what you know about disease to the human being in from of you in ways the patient can understand.
It is hard to see how Congress’s attempts to “reform health care,” which is really the realignment of third party payers and the rules that govern them, pertain to the practice of medicine. That’s not to say that some ideas are long overdue—the idea that risk pool must be expanded, that “pre-existing conditions” must be accepted, that reliance on employer based health insurance can be a competitive disadvantage for domestic companies in a global market, and the realization that health care costs must be controlled. But how, exactly, is political posturing in Washington supposed to help me practice better medicine when they can’t even see what is obvious to most physicians?
The failure of Obama to capture this is either a failure of imagination, a sellout to the trial attorneys lobby, an utter disregard for physicians, or a mixture of all three. Needless to say, it is a blow to physicians who care about patient. And even if malpractice reform does little to reduce the costs of health care, why did Obama politically ignore it? It’s a slam dunk. Throw the physicians a bone.
Regardless of what you think, I love what I do behind the closed door of my exam room. And I often wonder who is going to be my doctor. I am so far healthy, late thirties, and have not needed any serious acute or chronic long term medical care. But when I do, will my doctor see me as a liability? Will medicine attract bright diagnosticians, talented surgeons, and dedicated nurses?
Although medicine is a calling and many will answer, I am not sure the current proposals from our politicians give me hope that I can walk into a medical office or be carried into an operating theatre or emergency department with confidence that my treating physicians and nurses will have my best interest in their hearts.
Ernesto Gutierrez is a rheumatologist.
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