A doctor who gets fifteen minutes with Mr Obama says…?

HCPLive , an online, medical news site tweeted this question:

If you had the president’s ear for fifteen minutes, what would you say to him about the current state of our health care system?

Ok then. This is a good one. You can just type it out free lance–for fun and all, snark-free, with a whiff of serious.

Since I am a cardiologist, and we are used to getting our way, I will take my fifteen minutes with the president on his basketball court. I think better when sweating, and not wearing those terribly stifling ornaments of politics and academia: ties and uncomfortable shoes.

First, let’s be realistic, I am not going to rant and rave to the president of the United States. More likely, I would freeze up, stutter, and default to a respectful tone. Though I would try to sneak words like vis-a-vis or writ large into the conversation—just to sound a little more East coast. (I was raised in Connecticut.)

Here goes…

After checking the ball, finding out what we are playing to (11 or 21), and wishing him good luck, I’d start our court-side chat with some hearty congratulations.

“Hey Mr President, I think it’s really cool that you are…

smart and well-spoken,

nuanced, (how about that for a smart sounding word?),

well-meaning,

focused on education (I love learning),

earnestly trying to improve our system of healthcare,

fit-looking (bike racers applaud low body fat),

…and, finally, the coolest one of all:

I think your wife’s mission to improve the dismal health of our youth is simply epic!” (‘Epic’ being the strongest vernacular a cyclist will use.)

On this last point about health, it should be known that I am not alone in touting Mrs Obama’s fitness campaign. The uber-fit-looking GOP congressman, Aaron Shock, has also endorsed Mrs Obama’s plan. Male-gendered masters-of-the-obvious the world over know the value of listening to good ideas from their significant others. First ladies rarely give their husbands a bad steer.

Ok now, I thought you were going to give the President some thoughts on our current healthcare reforms?

I am, I am already. Just hang on a second; I learned recently that all good politicians spend the first third of their allotted time accentuating the positives. Doctors are trainable.

Ten minutes left….

Mr President,

Here are three thoughts from a regular doctor who really likes his job:

First, I would consider some minor changes to your advisory panels. They are skewed too much to the smart and thoughtful folk. I would suggest less nuance. For every pediatrician, I would have a general surgeon or emergency room doctor; for every person from Harvard or Yale, I’d have two from the Big Ten or SEC; and for every lawyer, I’d have a doctor and two nurses. You need less Boston, and more Indy; less Cabernet, more Budweiser.

Second, I would consider more attention to the crisis in doctors’ dissatisfaction. We are the ones who move the catheters, prescribe the medicines and if given the time, educate the patient on making healthier choices. Though it’s possible that your staff hasn’t mentioned this: our current system is rough on the spirit of doctors. The take-the-fun-out-of-medicine people are running amok. Intrusions to the doctor-patient relationship are breaking our hearts.

Did you know I have to sign my name, with a date and time, four times, on four separate forms, to perform a ten-minute evidenced-based procedure? Or…I have to spend five minutes of my fifteen-minute office visit filling out an e-form to prove that I am not defrauding the government by sending a bill. Or…hospitals are spending millions to hire consulting firms (of lawyers) to help them comply with the metastatic spread of all these evidenced-based “policies.”

Please don’t misunderstand, I want to improve systems that help minimize mistakes and prevent harm to people. On this point, me and Atul G are in complete agreement. These are important goals. But someone should have told you that the overwhelming majority of doctors (and surely nurses) are right-minded. Most of us in medicine measure our self-esteem by how well our patients do, not the size of our cars, or in my case, the lightness and lateral rigidity of my bikes. Really. Less forms, more trust. Less computers, more conversations. Less CT scans, more room for errors.

Thirdly, along those same lines, the killjoy of hyper-regulation, farcical quality measures, protocols-for-everything and stifling mandates not only beat down happy guys like me, but it also discourages talented young people from choosing medicine as a career. Dissuading young people from doctoring should be a “never event.”

I know you have seen that Americans outside of Boulder and Portland are looking older and unhealthier. You have also been advised that many of these people expect their blockages squished, smoking-related tumors excised, and stomachs stapled, tomorrow, and for free, without complications. All this argues for more doctors, with more advanced training, and more specialization. And if you could grant us one more wish: more time to spend with our patients. Please.

So I respectfully ask you sir…

In the current milieu:

Will talented young people dedicate more than a decade of their life to learn how to doctor–at the expense of not learning a lot else, like how to write a complete sentence, for example?

Will these same young people actually like medicine enough to stay past five o’clock, or squeeze an extra procedure in–or will Americans learn to patiently wait?

I guess my fifteen minutes is up.

“Did you see that jump-shot, sir?”

Timeout!

JMM

Disclosure: The “real” reason I wrote this essay is because HCPLive is offering a 25$ prize. That’s about what you would get for fifth place in a local criterium bike race. Typing this out was a lot less inflammation-inducing.