When the cause is right, politics and surgery sometimes mix

Responses to recent crises show that doctors can achieve advocacy goals

New York – When problems in the health care system threaten doctors' ability to practice medicine and patients' access to needed treatments, surgeons can 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 articles highlight some recent health care crises and the effective advocacy response by surgeons and physicians, focusing on patient education as the key to political change.

Dr. George E. McGee and coauthors review the medical liability crisis in Mississippi during the late 1990s, prompted by multimillion-dollar jury verdicts in malpractice cases. Most companies providing malpractice insurance to doctors stopped offering coverage, while the rest hiked premiums dramatically. Many physicians were forced to leave the state or retire, leading to shortages in such specialties as neurosurgery and obstetrics. "The ratio of mothers to obstetricians in Mississippi fell below that of many underdeveloped countries," the authors write.

Rather than caving in, physicians in Mississippi--led by the state medical society--decided to fight back. Dr. McGee and colleagues sum up their approach to advocacy, which focused on patient education: Develop a consistent and credible message; Avoid hyperbole (the truth speaks volumes); Encourage all physicians to empower and activate their patients with facts; Acknowledge that media expertise is essential; and Communicate, communicate, communicate. The resulting public pressure led the state legislature to pass a comprehensible tort reform package, including a cap on noneconomic damages. The authors conclude, "With this, physicians began returning to Mississippi--to provide welcome care." Dr. Mini B. Swift and coauthors review the financial crisis at Alameda County (Calif.) Medical Center, which provides comprehensive care for indigent patients in Oakland, Berkeley and surrounding communities. Increasing debt and decreasing state and federal funds raised the threat of reducing services at a time of increasing need.

A physician-led advocacy group concluded that a new local tax was the only answer. A one-half cent sales tax proposal was placed on the ballot in 2004, but was given little chance of reaching the two-thirds majority needed for approval. Again, advocacy initiatives focused on patient education. The message focused on the benefits to patients, highlighting the plight of uninsured patients, the threat to the area's "safety net" hospital, and the regional value of the trauma center. When voting was over, the health care measure had passed by a 71.5 percent majority. "[T]he improbable evolved into the unbelievable as the fervor of a few became the mandate of the many," Dr. Swift and colleagues write.

Surgeons and physicians have an important role to play in addressing the challenges facing the U.S. health care system, according to Dr. Andrew L. Warshaw, Surgeon-in-Chief at Massachusetts General Hospital and Editor of SURGERY. "Doctors must become educated about the issues, involved, articulate, and politically active in order to mobilize our patients, our legislators, and our payors through a coherent, cogent message," writes Dr. Warshaw. "We must work together with our patients in the political arena to change the systems that threaten to undermine their healthcare."

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About SURGERY
For 66 years, SURGERY has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons. Visit the journal website at http://journals.elsevierhealth.com/periodicals/ymsy/

About Elsevier
Elsevier is a world-leading publisher of scientific, technical and medical information products and services. Working in partnership with the global science and health communities, Elsevier's 7,000 employees in over 70 offices worldwide publish more than 2,000 journals and 1,900 new books per year, in addition to offering a suite of innovative electronic products, such as ScienceDirect (http://www.sciencedirect.com/), MD Consult (http://www.mdconsult.com/), Scopus (http://www.info.scopus.com/), bibliographic databases, and online reference works.

Elsevier (http://www.elsevier.com/) is a global business headquartered in Amsterdam, The Netherlands and has offices worldwide.
Elsevier is part of Reed Elsevier Group plc (http://www.reedelsevier.com/), a world-leading publisher and information provider. Operating in the science and medical, legal, education and business-to-business sectors, Reed Elsevier provides high-quality and flexible information solutions to users, with increasing emphasis on the Internet as a means of delivery. Reed Elsevier's ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).


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