What would you say?

What if you were about to have dinner with the most powerful Republican in the United States of America?

How would you answer if, knowing you were a doctor, he asked…

“Hey Doc, how is it out there, really?”

You stammer for a minute, perhaps because you are uncomfortable wearing that newly purchased suit.  The experienced politician might fill in the awkward silence with this…

“You know Doc, here in Washington, we see a skewed population of doctors.  There are either the academic guys who are writing all those guidelines, or the highly disgruntled ones who watch too much Fox news.  That’s why I am interested in your view.  I.am told you still see patients every day, that you are a real doctor.

Ok all, what do I tell this powerful man?

Obviously, I’ll have to be brief.  Politicians don’t like long speeches.

Let’s start with positives.

Should I tell him how much I love doctoring at this moment in my life?  Though the typical office day is too hectic and squished, it is wonderful to see the fruits of my labor. AF patients that are now free of symptoms and drugs, ICD patients who are still on Earth, and CRT patients who can breathe easier.  Yes.

Should I tell him how gratifying it is to work in the electrophysiology lab?  I could word it something like this: though learning EP took more than a decade, and it still requires an open mind to do well, performing intricate heart procedures alongside dedicated staff, with the most up-to-date electronics, all for the purpose of bettering humankind was a great box to check on career day.

And of course, I should tell him that my medical community is not fraught with abuse and fraud.  The majority of health professionals I work with are dedicated to doing what’s right for the patient.  Sure, they are human beings; they like to be valued appropriately and clearly some get the job done with fewer tests and more common sense.  But this notion that a few bad eggs are a representative sample isn’t the reality.  I don’t work with doctors that put stents in when they aren’t needed.

And finally, If he promised not to tell anyone, I might also whisper to him that doctoring was so cool, I would gladly do it for less pay.

But on the other hand…

Should I tell him how regulations have run amok?  That it takes patients 30 minutes to do the paperwork for a 15 minute visit.  Or that it takes me 5 minutes of that 15 minutes to document all the necessary items so as to show I am not fraudulently over-billing anyone.

Should I tell him that there are profit-conflicted doctors-in-cubicles thousands of miles away that are inserting themselves in the decision-making between myself and the patient?

Should I tell him that our current payment system pays me ten times more to implant a pacemaker than it does to explain the reason why it doesn’t need to be done?

How about this vignette?  It comes from my wife, a palliative care doctor who runs a business of one person—herself.  Early on in her business experience she showed me an invoice of a patient bill.  The charge for an hour of heart-wrenching time in which life and death were discussed was 180 dollars.  She was paid 80.  Try that with a lawyer, plumber or dentist.

Should I tell him that one of the major reasons for rising medical costs are that innovative treatments aren’t cheap?  For instance, take the care of acute stroke or heart attack  The science is clear that patient outcomes improve if the closed artery is opened rapidly.  This process requires the fury of modern medicine: trained emergency professionals, high tech equipment, modern pharma and doctors on call 24/7.  None of this is cheap, nor very amenable to chiseling.

That may be too much already.

I still haven’t spoke to his wife about how teacher unions are affecting the education of our young.

Please feel free to add any questions you might want me to relay.

JMM