Memo From The Editor

Leadership

By Marianne Dekker Mattera

Earlier this week I spent several stimulating hours at a roundtable discussion co-sponsored by Medical Economics and Across the Board, the official publication of The Conference Board, an organization of top business leaders. The focus was today's health care—what's right with it, what's wrong with it, and what should be done to come up with a smarter system.

Participating were five people who do a lot of thinking about the key issues facing physicians, patients, and employers today: Daniel Callahan, ethicist and director, International Program for The Hastings Center; George D. Lundberg, MD, editor in chief and executive VP of Medscape and former editor of JAMA; Alan Sefcik, VP, benefits planning and analysis, at AT&T; Karl Singer, MD, an internist and family physician in private practice in Exeter, NH, and physician medical director of Patient Care magazine; and David Guilmette, a principal at the consulting firm Towers Perrin.

We'll bring you a complete report on the roundtable in a June issue, but I wanted to share with you here some thoughts sparked by the discussion.

When the participants got around to the prescriptive part of the morning—what should be done and who should do it—the question of leadership arose. That's a key question, regardless of what changes are proposed: Who will make the changes happen?

After dismissing the federal government—wholesale reform being politically unappealing after the Hillary debacle in the early '90s—and organized medicine—ineffectual—there was talk of a grassroots, physician-patient movement.

Now, to me, the word "movement" conjures up civil rights workers and antiwar protesters, and I don't think physicians and patients will ever take to the streets demanding more cost-effective, more equitable, more accessible health care. I do believe, however, that individual physicians can exert a good deal of leadership toward those ends.

I found a prime example of just one thing doctors can do during a visit to my dermatologist two days ago. It was a regularly scheduled follow-up after melanoma surgery last May. During our discussion after the biopsy report came back, my doctor had told me I'd need further surgery—a wide excision and lymph node biopsy, to be exact. He was prepared to send me to a local surgeon, but suggested that I could also go anywhere I wanted to, including Memorial Sloan-Kettering in New York. But, he cautioned, he didn't think my health insurance, a point-of-service plan, would cover the care there.

I opted to go to New York. As far as I was concerned, we were talking about my life here and I wanted to go where cancer was their business. If the outcome was good, I'd worry about the bills later; if it wasn't, my heirs could worry about them. Not all people have the luxury of that sort of outlook, though. Nor do they have the kind of information they might need to make the decision.

My dermatologist knows this, and he's making an effort to arm himself with information he can pass on. First, he knew that care at Memorial Sloan-Kettering would probably not be covered by my insurance plan and made sure that I knew that when making my decision.

At my most recent visit, he took the next step: He asked me how much my treatment had cost and how much I had had to pay out of pocket. He wasn't being nosy; he wanted the information so that he could give other patients an idea of what to expect when they face a similar decision.

I willingly shared the information with him and I applaud him for his efforts. He can't restructure the way health care is paid for. He can't assure access to all services for all patients. He can, however, do all he can to make sure that his patients have all the information they need to make informed decisions about their care. And so can you. That's leadership.

 

Marianne Mattera. Memo From the Editor: Leadership. Medical Economics 2001;8:8.