When The Cause Is Right, Politics and Surgery Sometimes Mix

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Surgeons and health care politics

When problems in the health care system threaten doctors' ability topractice medicine and patients' access to needed treatments, surgeonscan play an important role as advocates for political solutions,according to a series of special articles in the April issue of SURGERY(Volume 139, Number 4, April 2006) published by Elsevier. The articleshighlight some recent health care crises and the effective advocacyresponse by surgeons and physicians, focusing on patient education asthe key to political change.

Dr. George E. McGee and coauthors review the medical liabilitycrisis in Mississippi during the late 1990s, prompted bymultimillion-dollar jury verdicts in malpractice cases. Most companiesproviding malpractice insurance to doctors stopped offering coverage,while the rest hiked premiums dramatically. Many physicians were forcedto leave the state or retire, leading to shortages in such specialtiesas neurosurgery and obstetrics. "The ratio of mothers to obstetriciansin Mississippi fell below that of many underdeveloped countries," theauthors write.

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Rather than caving in, physicians in Mississippi--led by thestate medical society--decided to fight back. Dr. McGee and colleaguessum up their approach to advocacy, which focused on patient education:Develop a consistent and credible message; Avoid hyperbole (the truthspeaks volumes); Encourage all physicians to empower and activate theirpatients with facts; Acknowledge that media expertise is essential; andCommunicate, communicate, communicate. The resulting public pressureled the state legislature to pass a comprehensible tort reform package,including a cap on noneconomic damages. The authors conclude, "Withthis, physicians began returning to Mississippi--to provide welcomecare." Dr. Mini B. Swift and coauthors review the financial crisis atAlameda County (Calif.) Medical Center, which provides comprehensivecare for indigent patients in Oakland, Berkeley and surroundingcommunities. Increasing debt and decreasing state and federal fundsraised the threat of reducing services at a time of increasing need.

A physician-led advocacy group concluded that a new local taxwas the only answer. A one-half cent sales tax proposal was placed onthe ballot in 2004, but was given little chance of reaching thetwo-thirds majority needed for approval. Again, advocacy initiativesfocused on patient education. The message focused on the benefits topatients, highlighting the plight of uninsured patients, the threat tothe area's "safety net" hospital, and the regional value of the traumacenter. When voting was over, the health care measure had passed by a71.5 percent majority. "[T]he improbable evolved into the unbelievableas the fervor of a few became the mandate of the many," Dr. Swift andcolleagues write.

Surgeons and physicians have an important role to play inaddressing the challenges facing the U.S. health care system, accordingto Dr. Andrew L. Warshaw, Surgeon-in-Chief at Massachusetts GeneralHospital and Editor of SURGERY. "Doctors must become educated about theissues, involved, articulate, and politically active in order tomobilize our patients, our legislators, and our payors through acoherent, cogent message," writes Dr. Warshaw. "We must work togetherwith our patients in the political arena to change the systems thatthreaten to undermine their healthcare."

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