Keep your wallet close. Keep your patient closer.
The November 2012 election was the most one-sided election of my voting lifetime. This was a referendum on the generations old debates about taxation and regulation, with Obamacare front and center.
The battlefield appeared even, to the pre-election observer—both sides armed with billions of dollars of ammunition and millions of community and political troops. When the smoke cleared it became obvious there was a decisive result; it was a massacre both nationally and in individual state battles. Partisan political soldiers left for dead everywhere. At least there was a battle of wills in places like Ohio and Florida. But, in California, the politicos didn't even have to leave the barracks.
The victory for taxation and regulation was so breathtakingly decisive in the Golden State, that some were left to wonder, "Why didn't we ask for more?" A single payer proposition, a universal MediCal or Medicare, may well have won in California if it had been on the ballot this time around. In that sense, California physicians lucked out politically. Obamacare wasn't the battle—health care exchanges were the compromise. Our future battle, the big battle over truly socialized medicine, will be over a comprehensive, single payer system (aka CanadaCare). That is yet to come.
At my surgical facilities in Silicon Valley, an almost funereal atmosphere pervaded immediately after the election. Amongst my colleagues (who held diverse views on the issues and the candidates), worries about change are on everyone’s mind—about new taxes and so many new rules for doctors, hospitals, surgery centers, insurance companies and medical device makers. No matter how one voted, the reality that change had come left even the most enthusiastic somewhat disoriented with a nagging thought—how will change affect me? Nobody I know has read the 2700 pages of Obamacare. I confess, I haven't gotten around to it either. I'm hoping to task Siri, the software siren on my iPhone, with that task in the near future. That's what computers are for.
I have no answer but a couple of pieces of advice as to how anesthesiologists can embrace these changes, shine as leaders, and potentially avoid a bigger health care battle in the future.
Anesthesiologists can be a plentiful resource.
Much of the contemporary health care policy rancor is driven by the increasing shortage of health care resources. This is an opportunity for anesthesiologists to spread their “surgical home” wings and make themselves known as a valuable resource that can fill in some of the shortfall. Be known as a physician who solves problems and leads. In this changing landscape of health care, I believe there will be lots of room for emerging models of care. If anesthesiologists don’t take advantage of these practice and leadership opportunities someone else will.
Put the patient above the rules.
There are tons of inscrutable rules coming our way. If you only have ten minutes to devote, try to spend most of them caring for the patient. Triage human contact over the silly checkboxes. If the rules call for you check a box for antibiotics that were already given at midnight, then check that box. If the Federal rules call for you check a box that said you saw a purple-striped Sasquatch, then check off you saw the beast. Don't fight over the trivial; it doesn’t help the patient.
Patients want to see their doctors.
Nobody cares about the rules when they are sick. They just want to see their doctor. That’s the real nugget of truth amidst those 2700 pages of Obamacare. So under these health care exchanges, we are going to be getting more patients this year, often at lower levels of compensation for services. See and respect these patients, I urge. Renew your vows as a physician, extend the hours if necessary and make the effort. Prioritize the patient above all else.
As soon as I saw the election results, my mind floated back to a single patient encounter. Several months ago, I got a 2 am call to see a laboring patient. I had been sound asleep in the call room, but I quickly got up, washed my face briefly and mentally prepared to see the patient. A bit groggy still, somebody whispered to me "MediCal," as I wandered to the patient's room. Some consider MediCal billing to be tantamount to charity care, and yes it does matter in certain conversations, but not to an anesthesiologist who continues to pride himself on bedside manner, and one who is about to see a patient.
"Luis," the patient's spouse met me outside his wife's room. He was very excited and happy to be soon a new father and took the time to tell me that he had specifically come to our hospital, because our "hospital is great, and the doctors are great." Luis had driven a long way to come to our hospital. He shook my hand, and later that night after his baby boy was born, he hugged me and introduced me to the rest of his family in the waiting area. He wasn’t worried about health care administration or the election results. He just wanted good care for his wife and son.
Luis and his family are among many new Californians who are also new MediCal patients coming our way under Obamacare. Nothing about Luis and his family suggested to me that they aspire to be anything but hard-working Americans. Rich or poor, MediCal or not, patients like Luis and his beautiful family need our consistent, high-quality care. They need our respect.
So, remember, California anesthesiologists: Luis, like everybody else, wants to see his doctor. He wants you to put patient care above the rules, the politics and the pundits. And while he may not explicitly know it—he will advocate for a physician managing his care from start to finish both at family holidays and at the ballot box. I believe it really is that simple. Embrace these patients, or the next "change" election may not be a giant book of rules and taxes, it will be CanadaCare and possibly our Waterloo.