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What Docs Need to Know about the Political Process


We live in politically acrimonious times, and doctors are particularly ill-equipped to influence the process by the nature of our selection, training and experience, according to Jeff Brown, MD.

We live in politically acrimonious times. This is partially because politics are always acrimonious, partly because voluminous information is instantly and widely available, and partly, arguably, because we have experienced more change in our lifetimes that the political process simply has not had time to digest. And doctors are particularly ill-equipped to influence the process by the nature of our selection, training and experience — and the relative lack of unity and participation in our organizations.

So I thought it would be useful for our patients' welfare, our pocketbooks and our blood pressures to briefly review an insightful article by Robert Guyer, Esq., that appeared in 2008 in The Physician Executive, the magazine of the American College of Physician Executives. (The best professional organization I have ever belonged to, by the way.)

In his article, Guyer reviews some perspectives about “the way things work” that often confound doctors in dealing with the political process. And one thing that we can all agree upon is that American medicine has never been under so much strain and has never been so in need of better informed doctors to step forward and get involved. So consider:

1. No legal obligation

It might be shocking to some that lawmakers are under no legal obligation to make rational or fact-based decisions — unlike us, presumably. So we need to learn, non-cynically if possible, political facts.

2. Preference for support

Lawmakers will generally listen to those who have supported them more than others. That means campaign contributions are required to build and sustain political relationships. And long-term relationships will always be more substantive than lobbying de novo on some isolated issue.

3. Plead, petition, entreat

Like it or not, we cannot neither abrogate our personal responsibilities in these matters nor fully transfer our duties to lobbyists or consultants to tend to them. But, again, because of the way we were selected and trained, those doctors who find it difficult “…to plead, to petition, to entreat..,” especially to those we perceive to be less educated or inferior in some way, “...those docs should not be lobbying.”

4. Fickle minds

Government officials, in general, and lawmakers, in particular, may be as capricious and arbitrary as they wish. And these are the people that we are trying to influence, persuade and “make a sale,” if you will.

5. Who are the customers?

Lawmakers, unlike our patients, pharmaceutical reps, etc., do not need our business. We need theirs; they are our customers.

6. They are wary

Further, they know full well what our roles are and we start the process with them having some level of suspicion about our motives.

7. Being effective

If it isn't clear by now, realize that doctors are unschooled and inexperienced in governmental matters, in spite of years filling out feckless forms and increasingly being at their mercy. We are in some serious need of schooling in the political process if we are to be effective participants and not just bystanders.

8. The team mentality

Lastly, practicing doctors need a profession-wide, late-in-the-game catch-up on how to reorganize our thinking and approach to functioning in a complex, rapidly changing, team-based system. Being the Lone Ranger may have worked in decades past, but is now long past its best-if-served-by date. And further, the necessary improvements in our attitudes and knowledge base about medicine's changing place in society need to start with a serious recalibration at the medical training level.

Change is needed

I have heard rumors of a new Flexner-like report on needed changes to the American system of educating future doctors coming out of the American Association of Medical Colleges. It will likely deal with juggling the scientific content and heuristics of medical training — no small task to meet the unprecedented and rapid advances occurring in medicine.

But as far as recommending some fundamental change in future medical training that would improve how medicine is organized and delivered in America in the 21st century, if the AAMC even touches on the subject in its report, and by rights it should, I would be happily surprised if the report amounts to anything more than just rearranging the deck chairs on the Titanic.

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