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Grand Rounds revolved around advice for some guy whose name rhymes with “no llama.”  Perhaps the advice had merit, but that is not really what I want to tell our next president.  This post is the first (hopefully) of a series of posts that give my advice from the trenches.  It is unlikely that he will hire any primary care physicians who truly understand our situation, so I am going to act as if he has asked me for my opinion.

Does my opinion matter?  It does to me.  It does to my patients.  And I think I do speak for many in my position – primary care physicians in small private practices.  We make up a huge percentage of all primary care physicians, yet we generally are without a voice.

So here goes:

Dear Mr. Obama:

I don’t envy you for the task that you have ahead of you: fixing healthcare.  It is a real mess.  I know, because it is where I live for most of my life.

When you enter office, you will get a whole lot of “educated” advice as to how to fix the messed-up healthcare system.  Politicians who have legistated for years, advisors who have advised for years, smart guys and gals from the press, and the ultimate smart people – the academics – will all tell you what is really going on in our system and how to fix it.  Perhaps you will hear from the great big bodies of doctors: the AMA, and specialty organizations will pitch their pleas to you on behalf of their members.  That is all fine and good; but most of them only know about the healthcare system, the don’t know the healthcare system.  If a scholar or journalist spends years studying you, will he/she know you as well as your wife does?  That is what I am talking about.

So I am writing you this letter from the trenches of medicine.  I spend my days in exam rooms with patients.  I get paid by Medicare, Medicaid, Private insurers, and directly from patients.  My office would be hurt terribly if Medicare reimbursement was cut.  I had a patient today who lost his insurance, has no money, and still wanted me to stay his doctor – as I had cared for him for over ten years.  I had to turn him away and send him to a clinic that cares for people in this situation.  If I did accept him, I would be defrauding Medicare unless I charged him at least the same amount that Medicare is charged.  All of these problems: from SCHIP to the uninsured, from drug company sales strategies to the Medicare donut hole, from electronic medical records to HIPAA – all of these things have a huge impact on my day.

When people see me for a problem, I often tell them that it is far easier to tell the what is not wrong than what is wrong.  In the same way, I can tell you a lot more about what won’t work in the plans to help healthcare that what will work.  It is far easier to criticize a position than to defend one.  So I intend to be as constructive as possible.  My job is to care for people, not make policy.  But policy will more directly affect me and my patients than it will those who make the policies.  Simply put: your decisions could make me love medicine more or less.  Your choices could make my patients live or die.  Your plans could make things better or worse.  Regardless of my political affiliation, I am rooting for you on this one.

So before I dive into this presumptuous role of advisor, let me give you my background:

• I am board-certified in both Internal Medicine and Pediatrics
• I have practiced for over fourteen years
• I own one-third of our practice, which has four physicians and two physician’s assistants
• I have overseen the transition of our practice from paper to electronic medical records
• Our implementation of electronic records is good enough to win us national acclaim
• I have spoken around the country on the issues of electronic records, pay for performance, and running a private practice
• I have written for publications on the subject of practice management
• My practice has over 10,000 active charts, of which over 3000 are my patients
• I am in my mid-forties, and so hope to practice medicine for 10-20 more years
• If I took of time to really serve as a government advisor, I would hurt my practice and abandon patients – so I think this is the best I can do.

There is lots to tell you about what is happening in my neck of the woods, but will let that wait until another day.  I just hope that you listen to advice from people like me – not just for medical problems, but for energy, unemployment, taxes, and anything else that directly affects the public.  Please don’t just listen to the people “important” enough to make it to your parties or cabinet meetings.  Listen to the people in the cross-hairs.

Listen to us.

Sincerely,

Dr. Rob

Tagged as: Healthcare, Medicare, Obama, Priamry Care, Uninsured