I don't get to watch too much TV. But as my kids will tell you, there are a few shows (like Maddow) and commercials (like the "you saved scooter" rabbit-saved-by-balloon-shock-therapy ad) that I enjoy. However, one commercial drives me nuts - and it is playing incessantly on my cable - Dr. Ami Siems and Patients First. She's the Family Practitioner "who's been in practice for 18 years and is concerned that some in Washington are making plans that could lead to governement control of healthcare." As a physician I took an oath to "first do no harm." While some might say that this only really applies to direct patient care (e.g., don't do unneccessary surgery), I would argue that this applies to the entire doctor-patient relationship, including what we say about healthcare reform.
"Patients First" is running Dr. Siems over and over on our local cable channels....so often that it is hard to avoid (I've managed to block Fox News entirely, but I can't block EVERY channel). If you haven't seen it here is the link (or see the transcript below):
VIDEO:
"Patients First"
TRANSCRIPT:
"I've been a family doctor for 18 years and I'm concerned that some in Washington are making plans that could lead to governement control of many Americans' healthcare. I think that's dangerous. Bureaucrats should never be able to deny or delay the care that doctors provide...and if the government starts to take over healthcare, your choices could be reduced ..healthcare could be rationed ... quality would suffer. Washington already controls Medicare and Medicare will be bankrupt in 8 years. Despite this looming banbkruptcy, some want to pay for healthcare reform with 500 billion dollars in medicare spending cuts. And look at Canada and England where government controls healthcare....patients wait up to a year for vital surgeries....delays that can be deadly. So instead of forcing Americans into the kind of health care system that has already failed, Washington needs to fix Medicare first. Governement should never come between your family....your doctor.
Most of these Republican talking points/lies have been well-described elsewhere (see Devilstower and BarbinMD). I'm particularly fond of Siems' call to save Medicare, which is a government run healthcare system, which is dangerous (and reduces choices and rations and decreases quality), which is why we should save Medicare which is a government run healthcare system....
As a physician I'm disappointed that Dr. Siems has chosen to so blatently misrepresent healthcare reform, not only to her patients, but to my patients as well. As doctors, many of us took an oath at graduation pledging, essentially, to do our best to do no harm. Dr. Siems may actually believe that reform will cause harm and that she is upholding her oath. Her misrepresentations are so blatently wrong, however, that this stretches the imagination. If you ignore the issue of whether or not she is causing harm to patients by advocating against reform, she still fails in her reponsibility to inform patients.
Physicians who are speaking out about healthcare reform should treat it the same as when recommending any other treatment option. With healthcare reform, the American people are the patients and healthcare reform is the treatment. When agreeing to reform or no-reform, the patient (Americans) should be able to make an informed decision, a.k.a. give informed consent.
Looking at it from this perspective, how should a doctor recommend a treatment to one of her patients? In the old days, some docs took the "I'm a doctor and you're not" approach. Rather than seeing the doctor-patient relationship as a partnership, the doctor was the captain of the ship and the patient was to follow orders ("take two leeches and call me in the morning"). Today, I like to think many of us are slightly more evolved. While some things in medicine are black and white, many conditions and treatments are less cut-and-dried - patients need to be involved in decision making. In order to do so, they have to understand enough to make "informed decisions," which, in physician shorthand, is usually described as knowing the "risks, benefits and alternatives." When Dr. Siems takes to the airwaves opposing healthcare reform, she has the same responsibility to educate patients - so that they can make a rational, informed decision for themselves. Lies, half-truths and scare tactics are never acceptable in the education of patients...nor should they be in her very public discussion of healthcare reform.
Let's imagine a discussion of the H1N1 flu vaccine in Doctor S's office, based on Dr. Siem's presentation of healthcare reform, and compare it to the discussion in "Dr. GoodDoctor's" office:
Dr. S:
I don't believe in government interference in healthcare. Therefore provision of a governement-supervised and government-procured vaccine is dangerous. They do that in England for God's sake and people DIE there. Further, I don't think government doctors should be able to tell me which patients should get the H1N1 vaccine. Therefore, I will offer vaccination to my patients when and if I deem it necessary. If you don't like it you should find another doctor in Canada. Please pay your copay on the way out.
Dr. Gooddoctor:
The H1N1 flu is everywhere right now. As you probably already know, most folks who get it have a relatively mild illness and recover with supportive care. However, high risk patients (like pregnant patients and people under 24 years of age) can become severely ill and die from this type of flu. All of the evidence suggests that if you are in a high risk group you will benefit from a vaccination therby protecting yourself and your loved-ones. You should know that the vaccine is made by the same companies with the same oversight using the same techniques as the regular flu vaccine you get every year. Do you have any questions or concerns?
Of course, the Dr. S discussion of H1N1 is ridiculous....but so is Dr. Siems' commercial. So why did she choose to mis-inform not just her patients but everyone's patients about healthcare reform? One can only hypothesize. Maybe she's a good doctor but is a few cards short of a full deck on policy. Maybe she's an idealogue and conservatism is the only thing that matters. Perhaps she sees few uninsured patients at her Yukon OK practice. This is a bit hard to believe - Yukon has 6.6% of its population below the poverty line based on census data. Some private practices have policies that "expect payment at the time of service" and might discourage those who have no insurance. Perhaps she has had bad experiences with Medicare..... reimbursement cuts are frequently threatened and payments can be delayed. And, under Medicare, some treatments are not approved (some for good reasons, others not-so-much). Perhaps she worries about an "uneducated" bureaucrat telling her what to do. The thing of it is - is - she already has that situation with insurance companies NOW.
But perhaps - it is all about money. No-one wants to talk about the impact money has on physicians...we're supposed to be "above the influence"....but medicine is big business and physicians get paid by that big business. Rep. Jim McDermott (D) puts it a little bit less charitably about physicians opposing healthcare reform:
"The doctors who have responded this way exhibit a serious case of doctor greed," McDermott told FOXNews.com. "They have lost sight of the common good and the pledge they took in the Hippocratic Oath."
"These people are practicing fear without a license and they should be subject to a malpractice suit."
Medicare pays a lot less than most insurance plans pay. What does this mean? If your patient population is 40% Medicare, 10% self-pay, and 50% insurance, increased access to a Medicare-like public option could improve your bottom line (the self-pay patients usually pay less than Medicare currently because so many default on their payments - with a public option a doctor would get paid something rather than nothing). So that's good for a doctor's bottom line, right? On the flip side, however, if competition forces private insurers to cut costs, they are likely to decrease physician reimbursements (insurance pays less per procedure). Similarly, if private insurance is non-competitive and more patients enroll in a government system, this would also decrease physician reimbursement (fewer high-paying insurance patients). Finally, patients who currently don't have health insurancee may re-enter the healthcare system, proportionally increasing the number of patients with the lower-paying public option.
While many many many doctors support reform ( e.g. physicians for single payer), a significant number oppose any change. And many of my colleagues who worry the most about change are actually most concerned about how it will impact their own bottom line....whether they admit it or not.
A favorite saying of one of my retired partners is: "Tell the truth. Put patients first. Everything else will work out in the end."
The truth is this - the current system is failing. Even though it may impact our salaries, supporting the public option (or single payer) is the best way physicians can put patients first - and .... I firmly believe .... everything will work out in the the end