While my medical school classmates were deep in their sub-I’s, I took a year off and spent my days being chased off parking lots by grocery store managers. I often wondered what I was doing and how did I manage to drift so far from medicine.
I found myself in this unenviable position by trying to change the health care landscape. Health care in America is fragmented, expensive, and often ineffective. This has been self-evident for 20 years, yet the problem is getting worse. We have a health care system shaped largely by government policies and government dollars, and, conversely, we have a federal budget that is shaped largely by health care spending. Since I wanted to be an agent of health care reform, I thought the obvious way to do that was to run for a seat in the House of Representatives.
Sure, it is unconventional to run for federal office as a first-time candidate, to have no money or donors, and to have lived in the district for less than 3 years, but these are, in medical lingo, soft contraindications. The mechanics of running for public office is pretty much the same no matter which office—you spend your days begging for votes or for money, which in turn helps you beg for votes. You get the distinct feeling of being a panhandler, replete with being chased off from grocery stores. The only difference is that as a candidate, you are better dressed. People innately realize this because while many are politically opinionated, few ever imagine slumping to the level of a political candidate.
I met a lot of people on the campaign trail. I even kissed a baby I delivered. There were plenty of vehement partisan politics and many misinformed people. Through the process, I learned a few things. Politicians are a reflection of the interests they represent—no better, no worse. Health care is not an important issue for the average person shopping for groceries, nor is it an important issue for moderators during televised debates. Our government is a single entity that actually represents an incredible diverse amalgam of views. The process for change was purposely set up to be slow in order to preserve integrity and to give different parties chances to voice themselves.
These lessons from the campaign trail helped put health care reform into perspective. The United States is a republic or a democracy depending on who you ask, a few even argue it is an oligarchy, but by no means is it a technocracy. This means that as front line experts of the health care system, family physicians have no more influence than their patients over whether EMRs interoperate or whether the concern of data security means we must make important decisions with limited and outdated information.
Patients’ awareness of the system empowers them to change the system. Just as we have moved away from “doctor knows best” paternalism to a shared decision-making model centered on patient values, it is time for us to shift away from a culture that insulates patients from systemic health care issues. Since these issues increasingly impact the medical component, patients should be aware of the larger picture if only as an extension of their health literacy.
Not being able to track down a prior CT study should not simply result in a repeat scan; rather, it is an opportunity to educate the patient on EMR interoperability in the same way we educate patients on the effects of sodium on blood pressure. Running out of time during an office visit to discuss all of a patient’s problems is not an issue of other patients waiting, as is often presented, but really an issue of a byzantine rule formulated over 20 years ago that pegged office visits at 1.3 RVUs.
Surely, this is an uncomfortable concept. Thoughts that these subjects don’t fall in the scope of “medicine” abound or that in a 15-minute office visit, there is no time to do a thorough review of systems, never mind talking about health care issues. Yet similar objections regarding scope and time were raised decades ago at the thought of physicians consulting with their patients before deciding what to do.
Family practitioners interface broadly with the health care system and at the same time are the primary point of contact and education for their patients. Family medicine means practicing medicine beyond rote facts. Seeing the patient as an equal partner in bettering the health care system will take time, but if there is one specialty in medicine that can lead this transformation, it is family medicine.