February has been a hectic month for
women’s health issues. First, there was a fall-out and reconciliation between
the Susan G. Komen Foundation and Planned Parenthood. Then, religious
organizations fought back against the Obama administration’s plans to mandate
free contraception coverage through employers. Now, the news cycle has turned
to controversial legislation in Virginia and Alabama requiring transvaginal
ultrasounds for women choosing abortion. I have followed each of these
discussions with interest, but what has really bothered me was another story
that got relatively little attention yet indicates a troubling trend in health
care politics – the “doc fix."
On February 17th, Congress
passed a bill, more widely known for extending the middle class payroll tax cut
through 2012, that also included a “doc fix,” a stipulation that would prevent
a significant decrease in Medicare reimbursement to physicians. Reading the
fine print, this “win” for doctors came at the price of a $5 billion cut in
health prevention programs. In essence, the basic interests of doctors were
pitted against that of patients. It’s easy to imagine that the patients who
will be affected are the most vulnerable groups – the unemployed, working poor,
urban minorities, and the uninsured.
What aggravates me most about these
policy conversations isn’t the exact decisions that are made by our elected
officials. Rather, it is the immense silence of doctors in these
debates. Bishops, talk-show hosts, special interest groups, and even
comedians chime in, while doctors observe passively from the sidelines.
Shouldn’t doctors want to engage in the crucial discussions that impact our
daily work? It seems to me that physicians could be quite an influential voice,
if only we spoke up. So, why don’t we?
I believe that the passivity is a bad
habit. Starting with the first two years of medical school, trainees spend
almost 24/7 hiding in the library, cramming our brains full of facts and
algorithms. We rigorously reduce illnesses to short-answer responses. We learn
to quote journal articles to earn extra credit. During our clinical rotations,
we are rewarded for being able to rattle off the longest list of possible
diagnoses, or show up earlier and stay later than anyone else. We are never graded
on how well the patient does. Our existence is consumed by paperwork and
licensing exams. It is drilled into our heads that doctors should be scientists
– objective, data-driven, and emotionally-contained. Compassion and social
awareness are just other competencies to check off our graduation requirements.
Whatever passion brought us to medicine is put on hold while we jump through
all the hoops.
Eventually, we emerge from that rigid
program. Suddenly, we are faced with an irrational and political world. We see
that taking care of our patients require more than knowing their diagnosis and
treatment options. Mothers with cancer fail to show up for care because they
can’t find someone to watch their autistic child. Undocumented immigrants are
afraid of entering an emergency room with their bleeding masses. Struggling
small business owners can’t afford vaccines for their children. Working parents
are concerned about losing their jobs if they go to too many prenatal
appointments. Prescriptions often go unfilled. Sanitation, food security, and
safe streets do more for the public’s health, than high-tech surgeries.
So, physicians are faced with a
choice. We can keep our heads in the sand, and hope someone else will fix the
problems. Patients will probably still get adequate medical attention, and we
will make a good living for ourselves. Or, we can choose to become
well-informed citizens, take a side, and lead the charge in health reform. In a
democracy, when you don’t choose to speak, you give up your power. We doctors
have largely forfeited our influence as patient advocates, and allowed
lobbyists, insurance administrators and pharmaceutical executives to determine
how we practice.
Recently, my division director
happened to be in Washington D.C. for a meeting, and she took the time to visit
members of Congress to talk about the shortage of chemotherapy drugs for women
with cancer. She shared stories about patients with disease progression because
of treatment delays. She didn’t show complicated graphs or write a big check.
She offered what she knew – the struggles of her patients and her sense of
social justice. She threw her voice in with the critical mass of other citizens
who also wanted the system to change. And the federal government is responding
with measures to make more drugs available.
Speaking up is a simple solution, but it's not
easy. We need to break old habits of waiting to be told what to do. We have to
realize the fallacies of a culture of neutrality. Just the other week, I was
telling my best friend that I needed to apply for a health care policy
fellowship in Washington D.C. so I can really learn how things work on Capitol
Hill. She looked me in the eye and stated matter-of-factly: “You’ve spent
enough time in school. You need to go out there and do something now." Of
course, she is right. It is time to make our voices heard, as we are.
