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Doctors need a political clue

Ask any physician if there's something about the health care system that's broken, and you're likely to get an earful. Malpractice law usually heads the list, followed closely by declining reimbursement and intrusion by insurers and regulators into the doctor/patient relationship. All of these issues are so irritating for doctors in part because they can't be solved by physicians alone. Solving any one of them will involve going up against non-physician interest groups -- insurers, regulators, and trial lawyers -- that have their own ideas of what's best for the public and for themselves. In other words, doctors are going to have to fight and win some political battles.

This, by itself, is why doctors should unilaterally stop accepting all gifts from drug companies and medical device manufacturers.

Forget about whether it's legal. Forget about whether there are some vaguely plausible arguments that consulting fees and free lunches are harmless. Doctors need to convince the public that they, and not the insurers, bureaucrats, and trial lawyers, are the "real" patient advocates. They can't go on assuming that the public will trust physicians more than they will anyone else. Those days, if they ever existed, are long gone.

Because doctors won't stop playing footsie with gift-giving corporations, the public can read about how Medtronic "paid" $400,000 to one surgeon for eight days of "consulting work." They can read about how medical students are "acculturated" to accept gifts from drug companies, and about how "80% [of medical students] said they were entitled to these gifts because of financial hardship." (Here's the JAMA link, for those with a subscription.) Regardless of the propriety of these gifts, doctors can't just assume that patients and the public are going to buy their long-winded defenses of these kinds of lucrative relationships. When physicians are quoted in the newspaper defending questionable practices along with the deeply-distrusted pharmaceutical industry, they're digging themselves a deep political hole. People start to think their doctors are greedily chasing the money like everyone else.

Once we realize that we've got some important political battles to fight, physicians might be more inclined to come down hard on any behaviors that even smell funny. What would help doctors politically more than anything else is if the public could read about how the AMA and their state medical society were enthusiastically supporting a ban on accepting gifts from industry. Sadly, one of the authors of this article is quoted as saying he thinks "it's not very likely" that doctors will endorse the proposal.

I'm sure most doctors agree the consulting fees and the trips to the strip club aren't worth the hassles of a malpractice system that doesn't compensate injured patients or punish negligent doctors. The problem is that physicians don't seem to realize that these two issues are connected. But we're in the realm of politics, baby, and that means that trust is everything. Perhaps more than anything else, doctors must fight to earn the public's trust. Doctors, here's some political advice: get a clue. Stop accepting drug company gifts; make even the suggestion of improper influence manifestly absurd. You might have a chance to recover your leadership role in healtcare debates.


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Right on, carey. it's all connected. and docs do need a political clue. want to get involved in a newly formed organization of docs that actually tries to reflect the interest of patients and the public, and that leverages our privilege for better use? www.npalliance.org. hit me back if you've got a greater interest, there are some information house parties in your neck of the woods coming up in the next month. hope things are going well for you!

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