If you’re in medicine, you’re in politics

by Nicholas J. Rohrhoff

Each generation of physicians has no choice but to take on the responsibility of learning the science of medicine – how best to care for patients.  But current circumstances dictate that we must also bear the burden of developing policy that creates the best system in which to provide that care.

Creation of a 21st century American healthcare system will require engagement and effort from everyone.  In this endeavor, the role of physicians is special.  We are, first and foremost, the chief advocates for patients.  Far too often, this role absconds when we leave the exam room, hospital or clinic.

No more.

Awash in a sea of commentary from the press, politicians and pundits, one important segment of our society has been relatively quiet in the healthcare reform debate: tomorrow’s doctors.

No longer.

Today (Monday, February 7th), hundreds of future physicians from across the country, representing each year in medical school, arrive on Capitol Hill to meet with legislators as part of the American Medical Association’s Medical Student Lobby Day.

In relaying our desire to provide high quality care for constituents – our patients – we reaffirm that medicine is not a career, but a calling.  It is humbling, yet awe-inspiring, to know that our passion will be integral to the success of the healthcare system we are destined to inherit.

The foundation of that system and our profession is the doctor-patient relationship. But this sacred and uniquely human interaction does not exist in isolation.  It occurs in a complex, fragmented framework of physicians, nurses and other healthcare providers, hospitals, third-party payers, pharmaceutical and medical device companies, federal and state policymakers, lawyers, and more.

In other words, if you’re in medicine, you’re in politics.

Politics.  As a current or future physician, the response that word elicits is likely both monosynaptic and dissonant.  But if you listen closely enough through the cacophony, you can hear the patient whom you ran into at the grocery store last weekend say to her fellow shopper, “That’s my doctor.”

Like other stakeholders, we have resisted the label “special interest” because of its colloquial negative connotation.   But consider that, from 18-month old well-child checks to diabetes medication adjustments for elderly patients, each of the over 300 million people in this nation will have their lives touched, at some point, by a physician.

In that way, while medical students as a group aren’t necessarily a “special interest,” our interests are pretty special.

More than a century after the publishing of the Flexner Report on the status of medical education in America, the United States still offers the best medical training in the world.  Yes, we could easily be content in representing another iteration of that tried and true process.

But, if we acknowledge the obligation that comes with this unique opportunity, we can also become something even greater – a generation of progress.

Nicholas J. Rohrhoff is a medial student.

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  • Bobbo

    Physicians are a “special interest,” just like nursing, pharma, and farming And theres nothing wrong with that. In our system, if you don’t lobby for yourself and toot your own horn, it goes untooted. It may be a broken system, but just sitting on the sidelines will ensure that physician interests are ignored even more then they already are. This is a great move

    The only downside of a medical student lobbying day is that many medical students are unaware of the issues of independent practice and have a more idealistic view of medical care. Theres nothing wrong with a belief in expanding coverage, but it needs to be put into the context of realities of costs, malpractice, etc.

  • Alice

    I agree that medicine is political by nature of regulation, and for the vast majority your compensation and treatment. In truth….I think if you are a citizen you have a political responsibility…..ignorance in the voting booth is irresponsible.

  • ninguem

    I suggest a better title.
    “If you’re in medicine, you’re a political football.”

  • Jay W. Lee MD MPH

    if “all politics is local”, then it is critical for *all* docs to engage with their local markets to ensure that health care is high-quality, patient-centered, and cost-effective (irrespective of how you feel about ARRA or PPACA). ultimately, health care reform is about how local markets (yours and mine) respond to the current challenges in the health care system, not about what govt or insurance companies dictate to us. otherwise, we docs will have lost another historic opportunity to re-define how health care is organized and delivered to our patients. “they made me do it” should never be an excuse for our fragmented health care system because really, shouldn’t we docs be ‘they’? after all, “if you’re not at the table, then you’re on the menu”, right?

  • http://advocateyourself.blogspot.com Cheryl Handy

    Physicians, you represent a very important constituency – patients.

    Many patients advocated and lobbied for physicians during the healthcare debates. We were concerned that the government was
    (a) interfering with the physician-patient relationship
    (b) marginalizing the medical profession and
    (c) treating physicians as an interchangeable commodity.

    Many aspects of healthcare reform have done all 3 of the above and, among other ways, reimbursement rates reflect the fact policy makers consider “Physician A” to be no different than “Physician B.”

    In addition, policy makers have created an environment where physicians and patients have become distrustful of one another. That distrustful environment is almost a prerequisite to patients and physicians buying into the “interchangeable commodity” aspect of the new healthcare reform.

    In order for the healthcare reform to work without a revolt, patients cannot feel a bond/trust with physicians and vice versa. Unfortunately, the lack of a bond/trust makes it more likely that a patient will sue a physician. No communication, no professional relationship, no sense of loyalty.

    Yes, physicians should be involved in politics. But physicians would be wise to remember that their constituents are the patients. Patients were very disappointed that so many physicians remained silent during the health care debates. Patients took your silence as an insult to us, your constituents.

    A word of caution: be careful with whom you lobby and for what causes you lobby. Your constituents are politically active and we have been waiting for about two years to hear our representatives (physicians) speak for us on the issue of protecting the sanctity of the physician-patient relationship and *reasonable* health reform.

    • http://fertilityfile.com IVF-MD

      You stated “In order for the healthcare reform to work without a revolt, patients cannot feel a bond/trust with physicians and vice versa.”

      I’m unclear on exactly what you mean, but I would offer this. In order for the healthcare reform to work without a revolt it has to either
      1. Be a GOOD type of reform OR
      2. The corporations that want it to pass have to be really good at using the media to trick people into accepting it

      Convince me that the specifics of a plan are smart and I will gladly support it. Otherwise, isn’t it normal to want to defend ourselves and our families from others who try to take away our freedom?

  • http://www.picumd.com PICU MD

    I think we need to provide high quality care for patients without cannibalizing our profession. There are already fewer and fewer people going into primary care. Unfortunately for the public, I think the best way to address this shortage is with cash. If primary care folks make a solid 50% above what they do now you’d see people willing to put up with more of the paper pushing and beaurocracy that surrounds “coordination of care”.

  • http://advocateyourself.blogspot.com Cheryl Handy

    IVF-MD:

    “1. Be a GOOD type of reform OR
    2. The corporations that want it to pass have to be really good at using the media to trick people into accepting it

    Convince me that the specifics of a plan are smart and I will gladly support it. Otherwise, isn’t it normal to want to defend ourselves and our families from others who try to take away our freedom?”

    Oh, doctor, with all due respect, you have missed the whole idea of practicing medicine. It is about “patients first.” Right? It truly sounds like you don’t trust patients. It sounds like you prove my point that we need to get back to as close to the patient/physician relationship (without government intrusion) as possible. It is bad enough that managed care got involved. The more people that get between the physician and the patient . . . the worse the outcome for both of us.

    You is taking away your freedom? IMO, the government’s intrusion.

    Trust me on this – nobody is going to “trick” the American people to accepting anything. Most of us are smarter than that!

    My point is that the “powers that be” have (sadly) created a situation where in order for their version of reform to work the physicians and patients necessarily must not trust or even like each other.

    As a patient, I must buy into the government’s belief that all physicians are all the same, that you are all an interchangeable commodity. I must believe that when I go to a clinic or hospital, it does not matter whether I see a MD, PA, NP, RN, hospitalist or whether I have any continuity of care.

    As a physician, you must believe that we are all walking lawsuits. You must believe that we are just waiting for you to make a minor mistake so that we can sue you for every penny you are worth. Yippee. The patient has hit the med mal lottery.

    Then we, the patients, will sit on our collective large rear-ends and watch Jerry Springer reruns while you try to scrap a living together working in a research lab.

    IMHO, physicians blew it when they let AMA, insurance companies and other lobbying groups (that physicians naively thought had the medical profession’s best interest in mind) speak for them during the healthcare debates. You guys were generally silent and the companies that spoke for you did a rotten job. They made the space between physician and patient wider. Many patients were angry that physicians were silent during the debates. We felt “abandoned” by our physicians in the sense that we thought we were a direct, solid team with you guys.

    I get it. Physicians just wanted to practice medicine.

    Physicians need to get the lobbyists, governments, insurance companies, AMA, etc *out* of the patient/physician relationship. Easier said than done. Part of the way you are doing it is via social media. Me, the patient advocate, communicating directly with you (without risk management, insurance companies).

    Many middle income patients are choosing “concierage” physicians. Many lower income patients are choosing physicians who post prices and dont deal with insurance companies. Patients are *begging* for a real relationship with physicians. Patients dont want a relationship with physicians that require unnecessary “middle men.”

    The government is an unacceptable intrusion into the patient/physician relationship. Why? Because the government intrusion into medical care system necessarily requires that the patient/physician relationship as we know it cease to exist. (Medicare has been a disaster. Many of you wont even take the patients.)

    In terms of big picture, first, “managed care” changed the relationship. “ObamaCare” will destroy the relationship.

    Sure physicians are “in politics.” But why would physicians be lobbying in DC other than to say – stay out of our relationship with our patients?

    • http://fertilityfile.com IVF-MD

      I initially couldn’t tell from you statement whether we agree or disagree.

      I wholeheartedly believe that medicine should revert back to the time when it was a cherished doctor-patient consensual interaction. I trust my patients and our ability to work together to achieve their goals, which is exactly why we need to reduce the role of government, insurance companies and lawyers.

      That’s exactly why we should oppose this intrusion. When I say “Convince me that the specifics of a plan are smart and I will gladly support it” I’m explicitly referring to a plan that smartly minimizes the role of the aforementioned trio of saboteurs. Since this “reform” plan we are discussing does the exact opposite, it doesn’t make sense to support it.

      After re-reading your comment, I get the feeling that we’re actually on the same side.

  • http://www.littlepatientbigdoctor.com Haleh Rabizadeh Resnick

    Doctors are politicians and artists. This open minded and patient centered approach is the key to the 21st century integrative approach to health.

  • http://www.talktoyourunconscious.wordpress.com BobBapaso

    I try, but nobody listens.

  • doctor

    I am glad you are lobbying for future doctors, but hope you can listen to a current doctor. Everything is politics, and you’ll find mini governments with laws, lobbying, and consequences in your hospitals, insurance companies, and practices. Then your practice organization, the local med society. (Almost no actual practicing doctors belong to the AMA) Then deal with your municipal government, state government, and then you can use your left over time for the federal government. Oh, to be a starry eyed med student again! Agree with IVF-MD couldn’t at first pick up that Cheryl opposed Obamacare. As for not speaking out against it, may I venture to say that no one wanted to listen when we did speak out?