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Archive for March, 2009

I sat in rounds this morning and listened while two attending physicians, both extremely accomplished in the field, debated about what treatment was most appropriate for a particular condition.  Each was able to cite more than one research study to support their position and each had significant clinical experience to guide them.

I found myself thinking- how could a government committee come to a conclusion about which treatment is appropriate when two experts cannot come to an agreement?  Where does the physician’s clinical judgment fit into the decision-making process?

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This is first of what will be several posts about the responsibilities and role of patients in health/healthcare.  The first and foremost is that they must take responsibility for their own health and healthcare.  While people do not have a right to healthcare, they have the right (even, perhaps, an obligation) to manage their health in the manner they deem best.  This means that they are the primary decision-maker but it also means they are primarily responsible for their own health.

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This is a letter I recently sent to the Journal of the American Medical Association and the New England Journal of Medicine:

What about freedom?

Over the course of my medical education, I have spent a lot of time with physicians of many specialties, genders, and ages.  On each rotation the conversation inevitably comes around to the future of US healthcare.  While the range of opinions is wide, I am struck that so many physicians believe in the inevitability of a centrally controlled, national healthcare system.  Many physicians, convinced that health care is a right, support the development of such a system believing that it is the best way to improve access and/or control costs.  Others, who do not think such a centralized system is the right answer, believe that idea has too much political momentum to be stopped.  Practically all are frustrated with the current system- frustrated by the amount of resources consumed in dealing with the insurance companies (public and private) and frustrated by the high degree of control the insurers exert over patients and physicians.  

 

It is curious to me then, that, given the almost universal dislike for bureaucratic sclerosis and delay, so many doctors (and medical students) are either actively advocating or passively willing to accept a centralized system.  Why are we willing to exchange the tyranny of many bureaucracies for the even greater tyranny of a single Bureaucracy?  Such a Bureaucracy would dictate treatments to doctors and patients.  The Bureaucracy would also set and control compensation for all activities.  (In economics this is called a monopsony and it is as destructive as a monopoly)  Physicians become the slaves of the state and patients become the wards of the state.

 

Have we forgotten what it means to be free?  That freedom is our right- the right to own our lives and our labor and to dispose of them according to the dictates of our conscience- in a manner according to our own values.  If anyone is compelled to do something then they are not really free for compulsion is antithetical to freedom.

 

We must understand that by fighting for our own freedom- the freedom to practice medicine to the best of our ability- we are actually fighting for our patients and their freedom.  We fight to preserve the most precious relationship in healthcare- the doctor-patient relationship.  We are fighting for the freedom to partner with them in a voluntary association the focus of which is their well-being.   We are fighting for the right to try treatments we and our patients think could be beneficial even if they might not be entirely mainstream.  Fighting for the privilege to love our patients because they are ‘our’ patients and we are ‘their’ doctors.

 

The Bureaucracy does not revere the doctor-patient relationship- it seeks to replace it with a committee whose broad dictates and conclusions would apply to every situation but not really fit any.   

 

Do we want to be remembered as the generations of physicians who delivered their patients over to the bureaucrats?  who grew weary of standing up for their own freedom and that of their patients?  who grew so comfortable that we could not be roused to a good fight?

 

I close with a quote from Samuel Adams:

“If you love wealth better than liberty, the tranquility of servitude better than the animating contest of freedom, go home from us in peace. We ask not your counsels or arms. Crouch down and lick the hands which feed you. May your chains set lightly upon you and may posterity forget that ye were our countrymen.” –Samuel Adams

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in general- FREEDOM- in particular this blog is about HEALTHCARE- about addressing the problems in healthcare- cost, access, quality- by expanding the freedom of the primary stakeholders- patients and physicians.  How do we liberate medicine?  By liberating patients to make their own choices about their health, their healthcare, and their health insurance.  By liberating physicians to practice medicine to the best of their ability and training, without undue influence by government and/or insurance companies.  Such an effort is in keeping with the founding principles of this nation- individual responsibility/accountability/opportunity, limited government, and free markets.

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