Doctors Must Participate in the Health Policy Debate

Published January 1, 2003

Physicians in Southern California, often a laboratory for the nation’s private and government health care reform efforts, need to take an active role in educating their patients about what’s good and what’s bad in the U.S. health care system … and what a new system might look like.

But they need to be careful when doing so, so as not to sound like they’re advocating reforms that increase their own income while criticizing reforms that help patients achieve better access and lower costs.

Damage Control

A recent report from Harris Interactive concluded physicians rank among the top eight or nine shapers of the public’s opinion toward health care. They have been “an important conduit of anecdotes and horror stories about managed care to the media, Congress, and state legislatures,” the report noted.

“Many patients say their doctors have had bad things to say about managed care, and many physicians admit to badmouthing it to their patients. On many occasions, they have also led the charge for additional mandated benefits to be provided by health insurers–for patients they will then be paid to treat.”

Anmol S. Mahal M.D., a gastroenterologist in Fremont, notes “patients have almost total faith in their physicians.” But, he adds, they’re “suspicious of the health care system as a whole, including doctors in general.” That puts doctors in a difficult position.

“It’s a great thing that consumers are better informed,” Mahal says, “but sometimes it takes more time to answer their questions. And you have to redirect their impressions of things all the time. They get information from innumerable sources, not all of which are accurate. So we spend a lot of time trying to repair the damage.”

Often, he adds, patients get those different perspectives from their own teams of doctors. When that happens, he says, patients should turn to the doctors closest to them, their primary care physicians. “They’re the physicians who know the patients the most,” he explains, “and who should be getting reports from all of their providers. Patients’ best approach is to consult their PCPs, bring the various opinions to them, and seek a consolidated opinion.”

Marie G. Kuffner M.D., an anesthesiologist at the University of California at Los Angeles Medical Center, agrees that physicians rarely speak with one voice. “There are physicians out there who think the present system is so bad that the only thing that will fix it is a single-payer system,” she says. And she adds, “There are other physicians out there who vehemently disagree with that position.”

Entitlement Mentality

“What’s lacking today is what used to be the fraternity of medicine,” Kuffner laments. “We were all the same, treating patients, doing our thing. Today so much of medicine is a business, which has been forced upon us, and some physicians have lost sight of their noble and idealistic early feelings about medicine.”

But doctors mustn’t let the commercial side of medicine color their comments to patients about systemic reform, she urges.

“Criticism alone isn’t going to get us anywhere,” she stresses. “Patients need to be educated by their physicians about making decisions and having some responsibility in the health care system.”

The problem they face, she adds, is something the Harris report pointed out: “patients’ high expectations and the gap between reality and those expectations. Patients have become so used to the entitlement of medicine and to somebody else paying for it that they simply cannot abide paying for what they want.

“Doctors need to explain to patients that they need to have a voice in issues that are truly patient-centered–like access to appropriate care at the appropriate time.”

Rational Approach

Lytton Smith M.D., F.A.A.F.P., a family practice physician in Yorba Linda, adds that doctors who criticize the current system need to have a credible alternative. “The hardest part as we become antagonistic toward the system is to understand what will replace it,” he comments.

Many people today have to pay more of the cost of their own care, he points out, and they’re not happy about it. “They will start to force some type of change,” he says.

“All physicians should be involved and informed and should attempt to present a fair assessment of the issues to their patients–especially those who ask questions. That’s an important distinction. I don’t think it’s the physician’s role to lobby every patient who comes into the office.”

Smith further says, “Our purpose is to give appropriate and scientific advice to patients about their health care. The health care system, unfortunately, impacts on that greatly. I think we should comment on specific initiatives or bills if the question comes up.”

Smith believes it’s OK for a physician to talk about a particular issue in front of the legislature and how it would help or complicate a problem. “If,” Smith notes, “we know what we’re talking about, I think addressing it is appropriate.”

“The physician community has influence if it uses it,” Smith says, “but, unfortunately, it’s a very disparate approach depending on the physician’s attitude. Those of us who work in organized medicine probably have a more focused view based on the information we get from our association and our interaction with the people in leadership. And we’re probably a little more balanced in our approach than the individual physician who may be reactive in his or her approach to the problem.”

He adds: “It behooves physician leadership to develop an approach for patients to understand in as simplistic a fashion as possible a very complex problem. It’s incumbent upon our leadership to develop a very well crafted, well thought out approach that we can present to our patients. If we can develop a rational approach to the delivery of health care, patients will understand it.”

Russell Jackson is a freelance health care writer based in West Hollywood, California. His work has appeared in the Los Angeles Business Journal, Atlanta Business Chronicle, Managed Care Outlook, Healthcare Practice Management News, Clinical Trials Advisor, The Nexus, and more than two dozen other newsletters, magazines, and newspapers throughout the United States.