Friday, February 15, 2008

Sermo, Physician Leadership - Physician Empowerment Campaign Underway

As I indicated in my last blog, which highlighted the AMA’s call for an April 2 White Coat Rally on Capitol Hill to protest the impending 10.6 percent cut in physician Medicare payments, a physician empowerment movement is underway.

There are other signs as well. A physician only website, now two years old, has over 50,000 participating physicians talking to each other about, among other things, what do do to reform the health system. Recently two recent posts by Sean Khozin, MD, appearedon Sermo : 1) “Open Letter to the People of the United States; 2) “Open LetteCampaign: Let’s Make It Happen.”

Dr. Khozin had a powerful idea: an open letter to the media signed by thousands of doctors. . The time has come for us to stand up, speak out, and make our voice and presence felt in the national media, especially at the height of health reform interest during this presidential campaign. The media cannot ignore an open letter signed by 30,000 to 50,000 physicians.

The physician empowerment movement is underway and has multiple dimensions - the AMA rally, this open letter campaign, doctors challenging health plans, letters to the editor in national newspapers, and appearances on Public Radio and Public Television.

Here’s what I think doctors want and need.

More than anything else, doctors want and seek a voice, visibility, and reality in domestic and national reform. Pundits, politicians, health plans, hospitals, academics, and the media have dominated the discourse. And, because many regard the AMA as simply a doctors’ union, rather than a moving force for the social good, the AMA has partially lost its voice. It has also steadily lost physicians members. Only 1/4 of doctors belong to the AMA , but the AMA remains our voice in Washington on many issues.

So what else do doctors want and seek?

They want and seek respect. They are weary of being hectored and lectured by outside experts on how to run a practice and what strategies to use to become more efficient, safer, and more productive. They are tired of being lampooned in the New York Times as greedy entrepreneurs.

They want and seek reality. Nothing brings you closer to reality than treating sick or dying patients. They know what patients need and want, and what it takes to make them better or to accept their fate. They do not need to be told how to be compassionate.

They want and seek an end to the entitlement mindset. Medicine is and never will be “free.” Pretending it is so opens up the floodgates. It shifts responsibility away from patients to doctors. It fosters more doctor visits, often for minor problems. It overburdens already burdened doctors, who only have so much time in the day.

They want and seek realistic expectations. Doctors cannot make patients young, reverse behavior -induced illnesses, control most disease outcomes, of fix all problems with technology. These expectations invite lawsuits, and lawsuits invite distrust and defensive medicine, which cost up to $100 billion a year.

They want and seek direct patient interaction as the basis for decision making, rather than having remote third parties decide what is best. That is why 2/3s of doctor favor a market-driven system over single payer.

They want and seek to be respected for their knowledge, based on experience. They want to be partners of patients, rather than being told by patients armed with half-baked Internet information what to prescribe or what to do. An informed patient is a blessing, a misinformed patient can be a curse.

They want and seek health plans and authorities to know that data alone, no matter how massaged, manipulated, and manufactured, has limits in individual cases. Doctors know patients live, get better, or die as individuals, not as statistics. Using retrospective claims data to judge rank, and exclude doctors and to intervene in clinical decision-making is a perilous, chancy, and delusional game.

They want and seek the public to know that EMRs, PHRs, and electronic records, may be desirable , but impeccable computer-based records are not miracle-makers that assure quality, safety, and better care. They are ancillary tools – not something that will ensure perfect medicine. Medicine has always had a subjective humanistic side, called the Art of Medicine, and objective data, even if one calls it Science-based, does not, in most cases, make it “scientific.” Give me a doctor who listens, rather than one who records.

Doctors want and seek to be appreciated as economic beings , subject the same laws of economics as patients, with demanding creditors, heavy educational debts, rising overheads, limited incomes, and with only so much time to spend with each patient in order to meet their obligations. The myth of all doctors as privileged high earners needs to be debunked.

1 comment:

rlbates said...

Dr. Reese, I wish I had written this. Thank you!