If the government was a physician

If the government was a physician, it wouldn’t be an ordinary doctor like you or I.

It would be a sexy actor like the ones we see on those medical melodramas that have become so popular over the last few years.  His hair coiffed, his jacket pressed and free of stains, and his manor confident he would rush into the trauma bay.  As the beeping monitor flat lines, he would sweep the nurses and residents out of the way, grab the paddles, and shock the poor patients heart back to life.  The wife and children would rush in and profess love to their newly awakened father.  And the super cute head nurse would glance appreciatively at our hero and wink with not so subtle romantic overtones.

Of course, any one remotely involved in health care knows that this is a farce.  Wipe away the syrupy made for TV moment and what we are left with is one simple medical fact.  You don’t shock asystole, it’s useless.  Such subtleties are often lost on those who shape today’s health care policy.  And who could blame them?  Most are politicians, administrators, or physicians who have long forgotten the practice of medicine.

Given the set of circumstances, the ACA is more sophisticated than it first appears.  In fact, much credit must be given for the emphasis on demonstration projects.  This is basic scientific method at it’s best.  Try a bunch of ideas and see which stick.  I couldn’t be more in agreement.

To Medicare’s great embarrassment, recent demonstration projects have shown little measurable benefit for the lynch pins of health care reform: pay for performance and patient centered medical homes.  There is no doubt in my mind that the same will eventually occur with ACO’s.  The problem arises, however, that in Washington, political expedience often carries more weight than courage.  In other words, it may be of no benefit whatsoever to shock asystole, but when the film is rolling, the defibrillator paddles are charged and ready.  It’s a million dollar fundraising moment.  Politicians like these.

But when the lights are turned down and the cameras shut off, we are left with a doctor who knows nothing of the practice of medicine and a health care system wrought with perverse incentives.

We need the real thing.

Not just someone who plays a doctor on TV.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion.

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  • JackBluegrass

    “If the government was a physician, it wouldn’t be an ordinary doctor like you or I.” I agree. But, I see that government as having Dr. Gregory House’s personality in a physician totally lacking in Dr. House’s diagnostic and therapeutic ability. Fortunately, most real physicians have a tolerable personality (at least) in a professional who will do their utmost for their patients.

  • Luana Thermos

    “His hair quafed.” That should be “coiffed.”

  • http://twitter.com/jlpham Julien L. Pham

    Lots of spelling errors here. Coiffed, manner, monitor… got to farce in the second paragraph and simply stopped reading. This site ought to do a better job at editing.

    • http://www.kevinmd.com kevinmd

      Sorry, it’s fixed. Dropped the editing ball here. Thanks for bringing it up.


      • militarymedical

        Agree w/comments regarding spelling and grammar. This happens way too often on this otherwise great site (not sight, a mistake that has also slipped through before) – and undercuts the credibility of discussions. Communicating ideas clearly and correctly is imperative for physicians and others. If you can’t spell or describe a condition or an issue properly, how is any patient going to take you seriously?

  • http://www.facebook.com/josh.hyatt Josh Hyatt

    Although the analogy to the TV doctor is interesting at first, as you read the article it does not provide any substance to support this assertion. Health policy is not developed by politicians. Health policy is developed by people that involved in the health care system operations and research (which often times are lobbists), which I believe is why there are so many incentives in the plans. The politicians review the different positions promulgated by these different “experts, take a position and defend it to the bitter end, usually.
    If you are going to assert that programs do not work, please support your position with facts. There is a lot of hyperbole and raw emtions out there with little valid, non-correlative evidence. Many of these programs that are being proposed and enacted are programs that have been researched, trialed, studied, and often times are sucessful models from states (ACA is based on the Mass. plan) or even other countries.
    I think that our health care access system is in asystole. But what is the solution, not try to recover it? Where the analogy falls short it this, the health care access system is not one individual in asystole. If we do not find a way to revive this patient and try every option on the table, then many others will die.

  • http://twitter.com/RebeccaCoelius Rebecca Coelius

    There are many active or recently practicing physicians on both the ACA and HITECH teams, and hundreds if not thousands more are consulted throughout the process. The programs that use quality measures are even more careful to ensure they are developed using active physicians within the relevant speciality or come directly from outside, physician led groups like AHRQ. I’m not saying that these policies are remotely perfect- but inferring that physicians weren’t involved or that the very idea of ACOs and PCMHs didn’t come out of the academic medical community itself is just wrong.

    Yes there were and continue to be physicians who work there who no longer practice medicine– but these people know more about the business of medicine on a systems level than the majority of practicing doctors, and have taken years out of their life to take on a terrible salary and often uproot their families to try to make the delivery system work better. Frankly I feel disgusted by our profession when we castigate each other for not being “a real enough doctor to have an opinion”- whether that’s because somebody went into the “wrong” specialty, or is an MD who decided that developing expertise in a business or technical area would give them greater leverage to help patients than direct clinical care. So many physicians complain that they want more MDs in administrative physicians but then call them “suits” when they get there. So we have situations like docs not up on their medicine practicing one or two weeks out of a year so they can claim to be “real doctors”. Our attendings like this at the academic medical center where I trained were borderline worthless when it came to complex clinical decision making.

    Its an absolute tragedy when bad policies inhibit clinical medicine and hurt patients.
    Doctors on the front lines of care delivery should be an integral part of any policy making process (and patients and other types of providers too!). But feeling the pain of a badly designed system and understanding a focused area within clinical medicine is NOT equivalent to having the connections, knowledge base, and charisma that must be developed to actually create broad change, whether within the private or public sector. These are skills worthy of respect, just like a master clinician, and both professionals need each other to get anything of quality done within our healthcare system.

  • Molly_Rn

    Your analogy doesn’t hold water, just shows your bias. So donate more money to the Romney campaign and then you will get the coiffured hair, pressed suit, the whole I am better than you leader who know nothing.

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