Friday, June 16, 2017

Time for a Doctors’ March on Washington

By Danielle Ofri



Recently, a patient with end-stage kidney disease told me that his insurance company stopped covering one of his essential medications. It took me hours of phone calls to reinstate this lifesaving treatment. Another patient — frail and elderly — was on the verge of having to move to a nursing home. An intensive blitz to coordinate visiting nurse services, physical therapy, Meals on Wheels and home hospice allowed her to stay in her home.

Advocating for patients is as much a part of medical care as the medical care itself. Diagnosing the problem and prescribing the treatment helps only if the patient can actually get the care. So doctors and nurses spend much of their time fighting on patients’ behalf with hospitals, specialists and insurance companies.

Should that advocacy extend beyond the doctor’s office, when politics has palpable effects on patients’ health? If my patient with kidney disease loses his health insurance, it would be just as life-threatening as the loss of his medications. As his doctor, am I equally obliged to advocate politically to ensure that health insurance remains available?

Right now, the Senate is considering health care legislation that threatens the coverage of millions of Americans. The American Health Care Act, which the House passed in May, would slash Medicaid, raise rates, increase deductibles, cut subsidies and weaken patient protections. Losing insurance — or being priced out of the market — is tantamount to losing health care. For patients with cancer, heart disease or diabetes, disruptions in medical care are as grave a threat to health as blood clots, metastases and sepsis.

Most doctors see an intrinsic distinction between calling an insurance company and calling a senator. The former is part and parcel of patient care, while the latter feels like acting on one’s personal interests or opinions.

But in terms of our patients’ health, there is a moral argument that they are equivalent. In our day-to-day lives, doctors and nurses put our patients’ needs first. We must do the same when our government proposes health care legislation.

Medicine is often practiced in what feels like a cocoon. There’s good reason for this — illness involves exquisite vulnerability, and patients discuss things they do not reveal elsewhere. When doctors and nurses close the exam room door, we are trying to block out the outside world metaphorically as well as physically.

Lately, however, the outside world has been muscling its way in. My patients frequently bring up politics — both those who support President Trump and those who think he is bulldozing our country to the ground. I try to stay out of it because these discussions could swamp what little time we have and because politics should never get in the way of the doctor-patient relationship.

There was a big hoo-ha late last year about a study with the erroneous title “Democratic and Republican Physicians Provide Different Care on Politicized Health Issues.” The study, in fact, demonstrated nothing about the medical care provided to patients. Rather, it surveyed doctors’ responses to hypothetical cases and then correlated that to their voter registration.

It found, for example, that Republican doctors were more likely than Democrats to say they would warn patients about mental health issues connected to abortion, while Democrats were more likely to say they would warn patients about the danger of storing firearms. While this study does remind us to be on the lookout for biases, it should not be taken as a call to minimize political advocacy on the part of medical caregivers.

Regardless of our own political affiliation, doctors need to examine how legislation affects our patients’ health. Texas, for example, now has the highest maternal death rate in the country, and perhaps in the developed world. If this were the result of a new virus or a side effect of a medication, the medical profession would be sounding the alarm. That the death rate is probably in part because legislation intended to restrict abortion has resulted in the closing of women’s health centers doesn’t make it any less of a medical emergency.

It’s heartening to see that medical groups are voicing their opposition to the American Health Care Act. But what about individual caregivers? Members of Congress need to hear from us, en masse, in our professional capacity. Just as we do not stand silent when insurance companies deny necessary medications, we cannot stand silent while our legislators’ actions threaten medical access. It might be time for the Medical March on Washington.

The mission statement for nearly every health care organization contains some variation on commitment to patient care. In the United States there are just under a million practicing doctors and more than four million nurses. An additional seven million or more are employed in the health care system. That’s a lot of voices that could be advocating for patients.


Danielle Ofri is an associate professor of medicine at New York University, the editor in chief of the Bellevue Literary Review and the author of “What Patients Say, What Doctors Hear.”

NYT

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