Ask Not What Your Country Can Do For You, But What You Can Do for Your Patient

As pundits sift through exit poll data, early analysis indicates the majority of voters thought the government did too much on health reform, but at least a third thought government did too little. There is still a lot of confusion whether the health reform law is a “monstrosity,” in need of repeal, or a “historic achievement,” worthy of implementation.

At the very least, the law needs review, by a more mature, chastised, Center-Right Congress, with a wide-eyed look at its more controversial, damaging elements – bureaucratic silliness of 1099 filings on all business expenses over $600, growing and dropping of coverage by insurers and businesses, impracticalities and burdens of setting up state health exchanges, expenses imposed on small and large businesses, and impacts on patients, limiting their access and choice of physicians and on physicians, prompting them to abandon the profession or ceasing seeing Medicare patients.

What can physicians do in this uncertain environment? How can they break out of the economic and clinical box the reform bill has placed them in – with lowering of fee reimbursements at far as the eye can see, pressures to install EMRs and to join with hospitals to form accountable care organizations, and the uncertainties and unlikelihoods of SGR and malpractice reform.

The answer, I fear, is : not much.

As physicians, we can curse the darkness. We can jaw about the looming access crisis. We can stop accepting new Medicare patients. We can become acquired by hospitals. We can implore Congress to provide incentives to bolster the supply of primary care physicians. We can highlight adverse consequences of the law – rising costs, lack of cost controls, dropping of coverage, escalating premiums.

Or, we can take inspirational and innovative steps to show the public and our patients our hearts are in the right place. In 1960 President Kennedy asked, “Ask not what your country can do for you, but what you can do for your country.”

His was a call appealing to the idealism of the young and the Peace Corps followed.

A national physician organization is making a similar plea, rooted in the idealism of doctors and appealing to the young. The logical messenger is the Physicians Foundation, a 501C3 charitable national organization representing 700,000 physicians in state medical societies .

The vehicle for their appeal will be Project Health, a kind of domestic Health Corps that mobilizes idealistic college volunteers, mostly bright pre-med and pre-health care career students, who seek to help heal the health system, fill in niches for people failing through the cracks, and acquire experience in the real world of health care.

Towards that end, the Physicians Foundation has given a generous grant to Project Health, the details of which will be announced soon.

According to the Project Health website,

“Project HEALTH's approach is simple but effective: We enable doctors to ‘prescribe’ food, fuel assistance, housing, or other resources for their patients, just as they do medication. Patients take these prescriptions to our Family Help Desks in clinic waiting rooms, where our college volunteers "fill" them by connecting patients with these critical resources. Last year, Project HEALTH trained and mobilized nearly 600 college volunteers serving over 4,000 low-income patients and their families in Baltimore, Boston, Chicago, New York, Providence, and Washington, D.C.”

For me the Project Health movement has tremendous symbolic significance. It strikes me as a way of breaking through the current political gridlock, as positioning physicians in a positive light, and as drawing national media attention to what physicians can do for patients without being perceived as whining or advancing physicians’ personal agendas. The Project Health movement is in the process of being extended to other cities and to other patient populations beyond children. I can see Patient Help Desks being established in multiple settings – community clinics, doctors offices, home care organizations, hospital outpatient facilities, wherever patients go seeking medical help.

It is time for reform inspiration rather than reform frustration and confrontation.