Physician Regulation - Checks, Balances, and Health Reform

Three events marked my day today.

One, I read a flattering review of Atul Gawande’ s latest book, Checklist Manifesto by Robert Wachter, MD, a West Coast academic who is a leader of the patient safety movement. If you’re unaware of Atul Gawande, he is a gifted writer and essayist who is a new doctor hero of the literary elite. He is a Harvard surgeon who serves on the New Yorker staff , where he blasted doctors in McAllen, Texas, for excessive care. He is a champion for more rational and more universal care. In Checklist Manifesto, he argues for a more systematic approach to care with checklists before, during, after surgery and other medical procedures. He says checklists are needed because medicine has become too complicated for even the smartest doctors to understand.

Two, I interviewed Philip Miller, VP of corporate communications for Merritt Hawkins & Associates, the largest physician recruiting firm and AMN Healthcare, a leading hospital staffing company. Phil has written a book Physicians In Their Own Words: 12,000 Physicians Reveal Their Thoughts on Medical Practice in America. In his timely book, he says excessive checks on physician behavior have led to angst and loss of morale, and the physician search for lifestyle balances between work and lifestyle have contributed to growing physician shortage. Miller mentioned, among other things, that medical students tend to look for success in the ROAD specialties( Radiology, Ophthalmology, Anesthesiology, and Dermatology) because of higher ehecks and more lifestyle balances.

Three, I had a spirited conversation with Tommy Hardin, a childhood friend and a Democrat from Oak Ridge, Tennessee, who now lives just outside St. Louis. Tommy was a trifle upset because my blogs favor Republicans over Democrats over health reform issues. True enough. I argued the debate between the two parties is all about checks and balances, as envisioned by our Founding Fathers, who set up the Constitution to set up checks and balances between the Executive, Judicial, and Congressional branches of government. I also argued each party will always give its own spin and interpretation to political events. As Friedrich Nietzsche said, “There are no facts only interpretations.” In other words, if you are either a Democrat or Republican, you will choose to believe what you want to believe, and facts are unlikely to change your mind. Calling the other side "liars" may make you feel better, but it doesn't elevate the level of the discourse.

I would like to encourage readers of this blog to submit more comments. That way, we can engage in intellectual combat, as Tommy and I just did.


Dr. Richard Reece is author of Obama, Doctors, and Health Reform (IUniverse, 2009) and Innovation-Driven Health Care (Jones and Bartlett, 2007) Both books are available at iuniverse.com, amazon.com, barnesand noble.com, and other book websites .