Who Speaks for Medicine?

August 13, 2009

The physician’s role in healthcare reform should not be sitting in the bull pen.  This professor and physician throws a mean curve ball and an interesting slider.  …worthy of a closer.

THE WALLSTREET JOURNAL, WSJ.COM  ~ JULY 24, 2009, 9:51 A.M. ET

Who Speaks for Medicine?

By ABRAHAM VERGHESE, M.D.

At a moment when everyone’s joining the debate over health-care reform, who speaks for medicine?

By ‘medicine’ I mean that ancient art and science with origins before Hippocrates, that discipline that has the patient at its center; I’m talking about the ‘medicine’ that deans across the country will invoke in a few weeks as they exhort first-year medical students to embrace the ideals and values of the noble profession.

[Verghese] Lee BennackAbraham Verghese, M.D.

Our esteemed medical societies and academies aren’t speaking for medicine; they are lobbyists, defending their financial self-interests, lining up for or against the latest bill being proposed. Our great academic institutions and our esteemed medical schools have historically spoken for the cause of medicine, but these days many medical schools are more like big companies with complex financial interests in large hospitals and clinical practices. What about the large foundations dedicated to health care, such as the Robert Wood Johnson Foundation or the Kaiser Family Foundation? I think their voices have become more potent as they seem largely free of the kinds of conflicts of interest that bind many of us, but they are not quite the voice of medicine.

Before we are irretrievably sucked into Washington’s political maneuvering, we desperately need doctors and nurses to speak for the art of medicine. As William Osler, the father and spokesperson of modern medicine said a century ago:

You are in this profession as a calling, not as a business; as a calling which exacts from you at every turn self-sacrifice, devotion, love and tenderness to your fellow-men. Once you get down to a purely business level, your influence is gone and the true light of your life is dimmed. You must work in the missionary sprit with a breadth of charity that raises you far above the petty jealousies of life.

For some physicians, that quote is risible. But for many others, particularly for our medical students, those words resonate with the passion that brought them to medicine.

The rhetoric I’ve heard from President Obama comes closer to Osler’s vision than anything uttered lately from high-profile doctors. That must change: Our leaders in Washington — Democrats and Republicans — need true physicians by their side, not just lobbyists, as they negotiate these next few weeks and months.

I know of primary-care doctors who give their weekends to clinics for the homeless; I know of specialists who volunteer their services to community nonprofits. At a time when many practitioners turn down Medicare and Medicaid patients because government reimbursements don’t even pay for overhead costs, others continue to treat them. Long before concierge medicine made house calls fashionable and lucrative, practitioners I know in Laredo and El Paso made home visits to the housebound, poor and elderly. And then of course there is our new Surgeon General—a dedicated primary care physician, a strong signal from the President about the kind of doctors the nation needs.

Physicians like those should speak up for medicine, and argue in favor of paying doctors to spend time with their patients. They should fight against a payment system that has created perverse incentives that encourage unnecessary treatments. Let’s make it as lucrative to talk to the patient as it is to do to the patient.

A physician who gets to know the patient can discuss difficult subjects such as end-of-life care while the patient is still relatively healthy — often sparing them the pain and huge expense of spending their last days of life in an intensive care unit. Physicians with good relationships with their patients can guide them away from futile therapies whose only proven efficacy is making money for drug companies, hospitals and doctors. How wonderful if all our lobbying societies would agree that our goal should be to fulfill Dr. Peabody’s old maxim, and not to simply restate it generation after generation: “The secret of the care of the patient is in caring for the patient.”

Abraham Verghese is a practicing internist and a professor of medicine at Stanford. His most recent book is Cutting for Stone.