7 minute read
THE EXPERIENCES OF A PHYSICIAN ADVOCATE IN THE POLITICAL WORLD
THE EXPERIENCES of a physician advocate
IN THE POLITICAL WORLD
BY LARRY L. LIGHT
EDITORIAL OPINION
Full disclosure, I know Mark Lopatin, MD, the author of Rheum for Improvement, pretty well and, in fact, have known him for many years. We’ve played golf together, and on that basis alone I consider him a friend. But beyond our friendship on the links, as a Pennsylvania Medical Society (PAMED) professional lobbyist I worked with Dr. Lopatin and numerous other physicians on the numerous and meaningful advocacy issues covered in his book. MOC, scope of practice, tort reform, prior authorization, etc.….all of them and more. As a PAMED lobbyist what I did not have, and as a physician he did, was the benefit of thousands of physician encounters. This book is about those physician encounters, the related advocacy issues and his engagement as a health care and patient advocate.
Continued on page 12
Knowing “ML” well meant that I was already very aware of his passionate engagement as a health care advocate. So I knew upfront the direction this book was going to take. It did not disappoint me. Though I did notice an unforeseen consequence that quickly became apparent. From the first page, the words I read came back to me in his voice. At first that was a bit of a distraction. But as a I read his descriptions of patient experiences, at least in my mind, it gave his perspective and contention for physician advocacy engagement view a more meaningful quality.
In its entirety, Rheum for Improvement validates a long-standing tradition that was unwritten but still a core element of PAMED advocacy, established before and maintained throughout my tenure. When we went to the state capitol to give testimony before a legislative committee, something that happened several times a year, PAMED was always represented by a physician leader. It was never the PAMED Executive Vice President and never a lobbyist.My recollection is that the American Medical Association (AMA) operates under similar guidelines. Many other professional associations in Harrisburg did not follow that rule. Their lobbyists were appearing regularly at public hearings. Their thinking being that having a familiar lobbyist carrying the message would work to their advantage and also save time for their busy member leadership. Our thinking was that a physician presenter guaranteed that the clinical aspects of the health care issue and the value of the patient-physician relationship would become part of the dialogue. I’ve always embraced that viewpoint.
The series of patient case studies or experiences related by ML strongly supported the PAMED physician-only policy. Quite simply the physician leader or another physician from the relevant specialty had the benefit of clinical knowledge. As lobbyists we could not come close to matching the depth of the patient-physician relationships that would be impacted by the policy change being debated. Even more clearly, we didn’t have the clinical training to present as an expert on the subject. There was no doubt, a physician was the only option and that was always the right choice. The depth of concern for his patients’ wellbeing related by ML validates that theory and becomes the de facto most persuasive argument in his book.
Rheum for Improvement takes the reader on the author’s journey through his private practice of medicine and allows him to relate his genuine concern for patient care in the context of the numerous health care policy challenges that physicians have unhappily navigated in their struggles to provide quality care. His frustrations with those policy issues, he later discovers, often run parallel with the issues high on the policy agenda of groups like the AMA and PAMED. For any practicing physician, outside of tort reform, those issues are primarily restrictions to physician autonomy either in statutory law or insurance rules. As described by ML in the plainest terms, those frustrations are always palpable and clearly become an ongoing source of professional frustration that also impacts his personal life. For ML, ceding control over clinical decisions in patient care was obviously not an acceptable outcome. And for the reader, given an inside view of his patients’ clinical circumstances, that is a welcome consequence. For his own professional satisfaction, personal peace of mind and most importantly for the benefit of his patients the logical course of action was engagement as a health-care advocate. He embraced the goal of having physicians’ “skills and clinical judgement be the driving force for health care decisions rather than bureaucratic mandates.” Given the state of health care in the United States and the power of insurers, trial lawyers and others, he quickly had a lot of issues on his plate.
I would suggest that ML expand his application of “grassroots advocacy.” His perspective in Chapter 11 is that grassroots advocacy is engagement outside of the organizational advocacy campaigns undertaken by professional membership organizations less structured than PAMED and the AMA. He relates grassroots advocacy only to his own later involvement in a wide variety of more aggressive and focused groups such as PAPA and PPA. In reality, he was engaged in grassroots advocacy from his first letter to the editor, if not before!
In healthcare advocacy, grassroots physician engagement is always valued. Like all advocacy, if done with respect for the policy maker and with a message of asking for help rather than directing an action, an effective level of aggressive reasoning can impact policy decisions. Because of their clinical foundation in the patient-physician relationship, physicians have that capacity.
The value of advocacy also emerges from ML’s initial exposure to election politics. He walked the walk by sharing his views and seeking support from the larger physician community. And he learned that political choices are often not simple. The caution is to realize that across the broad spectrum of political issues such as taxes, the environment, tort reform, the many aspects of health care and numerous other important policy problems it is unlikely that the candidate and the physician political
campaign supporter will find unform agreement. That is unless the physician steps up to become the candidate.
Policy makers at all levels, the news media, political candidates and the public in general all respond positively to the advocate wearing a white coat. It’s a strategy embraced by those non-physician providers who wear them to lobby at the capitol. They fill the capitol rotunda with white coats, just as physicians did to lobby for tort reform, because they want a piece of the patient-physician relationship.
They want to help their patients and provide care at the highest level of their clinical training. Fortunately, it would be nearly impossible to find a physician who did not embrace those same values while bringing significantly more education and training to the examination room.
My perspective is that ML gives appropriate attention to the value of personal involvement, relationships and local connections in the political universe, all important elements of grassroots advocacy. But I believe he misses the point that individuals engaging on behalf of themselves, the basic feature of grassroots advocacy, and also for their professional associations can produce the same high return from their local and personal connection with the advocacy target. He’s correct, it is the “core of politics” and the most important component of any effort to achieve “meaningful change.”
After I purchased Rheum for Improvement and accepted the challenge of this review there was one ironic point that I knew was obviously going to be my closing thought, even before I started reading the book. A PAMED President I worked closely with, John Lawrence, MD, in 1999 proposed that medical schools include a course on politics and the politics of health care in their curriculum. Having developed personal relationships with a group of legislators and government officials, he knew the benefits would follow. As it happens, Dr. Lawrence was also a rheumatologist. I was anxious to connect those dots and, quite happily, I discovered that they were connected for me when ML includes a short paragraph with the same recommendation (p. 179). I feel confident that Rheum for Improvement would be at the top of Dr. Lawrence’s syllabus for those courses. It also should be there for any physician advocate seeking to make a difference.
Dr. John G. Kuna & Associates
Psychological and Counseling services
Listening, Learning, Understanding
Evening/Weekend Appointments Available Most insurances accepted 12 Convenient Locations
DrJohnGKuna.com 570.961.3361
Melissa Draving, Personal Concierge, Owner
HELPING MAKE YOUR LIFE EASIER.
Errand Running • Pick-up Dry Cleaning • Drop-off Returns Personal Shopping • Household Management Light Housekeeping • Waiting For Deliveries • Personal Assistance
