Who are the most powerful people in American medicine?

Almost everyone I know considers the American healthcare system to be a horrible mess, although some that are deeply into it are quite happy with it. It serves their interests well.

Many do have big-time power.

There are lots of candidates for the “most powerful” title.

How about Regina Benjamin, the Surgeon General of the United States Public Health Service?

Maybe Kathleen Sebelius, the Secretary of Health and Human Services?

Consider Howard Koh, the Assistant Secretary of HHS for Health.

Many would name Donald Berwick, who heads CMS, thus running Medicare.

Could it be Walter Herger, the chair of the Subcommittee on Health of the Ways and Means Committee of the U.S. House of Representatives, or maybe Max Baucus, the chairman of the U.S. Senate Finance Committee?

Or perhaps President Obama himself?

Consider Francis Collins who runs the NIH, or Margaret Hamburg who directs the FDA, or Tom Frieden who is in charge of CDC.

Outside government, how about Harvey Fineberg, President of the Institute of Medicine of the National Academy of Sciences?

Or George Halvorson, the CEO of Kaiser Permanente?

Or maybe the presidents or CEOs of the American Medical Association, the American Hospital Association, the Joint Commission, or perhaps United Healthcare or Anthem Blue Cross Blue Shield?

Consider the dean of Harvard Medical School, or the editor of the NEJM or the JAMA, or the highly visible Dr. Mehmet Oz, or the New York Times‘ Gina Kolata, CNN’s Sanjay Gupta, or Quackwatch’s Steve Barrett?

A pretty impressive list of candidates, I do believe. Which one or ones are the most powerful?

Impressive though their individual and collective clout is, it is none of these powerhouses.

The most powerful people in American medicine are every patient, empowered by the dominant ethic of patient autonomy; the authority to say Yes, or No, to anything.

And it is every American physician, empowered by the dominant ethic of physician autonomy; the authority to say Yes, or No, to anything.

When working effectively together in the professional relationship, the patient and physician must and can continue to be supremely powerful.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.

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  • http://twitter.com/GlassHospital John Schumann, M.D.

    I vote for KevinMD!

  • http://twitter.com/HealthGrid Brian T. Edwards

    No question – Patrick Soon-Shiong. At least IMHO.

  • http://www.twitter.com/alicearobertson Alice Robertson

    I tend to disagree….it is the bureaucracy….it is risk management…doctors are in a straightjacket.  Although, your list certainly contains some real eejets:)

  • http://twitter.com/PamelaWibleMD PamelaWibleMD

    Amen George! It is when patients and physicians take back the power they have given away to politician saviors that all Americans will have ideal health care.

  • http://pulse.yahoo.com/_JG5UOZJNLLJE6HOT3KH4SS3UHM dude4U

    Physician autonomy

  • http://pulse.yahoo.com/_JG5UOZJNLLJE6HOT3KH4SS3UHM dude4U

    Unfortunately physician autonomy is great on paper but an illusion in practice.  By the time one is done fighting for precertifications (which are denied until your office staff spends an hour on the phone), changing prescriptions around because the script plan changed its’ formulary for the second time in a year and complying with ever increasing regulation there is little time to be “autonomous”.  Our patients suffer.  We try to fill the gap with “extenders” who have less training than the basic intern MD and then are expected to work without the type of supervision given to a resident MD.

    It is a sorry state of affairs.  Only to get worse.

  • http://pulse.yahoo.com/_JG5UOZJNLLJE6HOT3KH4SS3UHM dude4U

    Perhaps the title should have been “What happened to the most powerful people in medicine”

    Answer: Medicare/Insurance/Return on investment/Irrational exuberance

  • Beth_Boynton_RN_MS

    YES! YES! YES!  Dr. Lindberg, I think you are right on!  Please include nurses in the loop!  The power we have when we are in respectful collaboration with our patients and each other is the stuff that will heal healthcare and even the world!

    Beth Boynton
    Author, “Confident Voices: The Nurses’ Guide to Improving Communication & Creating Positive Workplaces”
    bethboynton.com

  • Anonymous

    Most patients don’t know they have any power in their health care.  They may think about changing doctors when they are dissatisfied, but not know how to find a better doctor.  And many are locked into managed health care plans that limit their choices–and their power.  Patients who really need to use their power–those who are chronically ill–are the ones least able to use it.  It’s just too hard to fight illness AND the health care system.  All of these things can be fixed.  Patients can become partners with their physicians, but only if the know that they can.  And should.  We need more patient education so the most powerful person in the healthcare equation can step up and participate.

  • Steve Rose

    The most powerful people in American Medicine, are individuals, and the single most important thing they can do is to stay healthy. 

  • Peter Schwimer

    Would that it were so. The truth is that there are very powerful lobbies in these United States, combinations of healthcare providers, pharmacueticals and insurance companies.  Most consumers still think that the provider is “god” and that he or she knows best.  They have not figured out that healthcare is a business like any other. And it is run by business people.