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.