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Healthcare Reform > Providers’ Eyes Stay DownCast.

This is part two of a four-part series that started by observing that you – fellow doctor or nurse – have been ignoring a critically ill Patient begging for our help. The quacks that have been (mal)practicing on this poor soul have been consistently the Patient worse. This now terminal Patient is named is Healthcare.

In the first post, titled “Physician! Raise thine eyes,” I presented evidence of the patient’s sickness and described the four principles of good medical practice not being applied to this Patient. I promised to explain the reason why our eyes stay downcast.

There are four reasons generally given for why we providers keep our eyes down. By far the most common is no time: we are too busy with individual patients to pay attention to The Patient. The old aphorism cannot see the forest for the trees seems apt for health care providers. Our eyes are so focused on the veins of one leaf on the tree that we do not see – rather than cannot see – the whole tree, much less the forest and certainly not the landscape.

I submit, with respect, that “too busy” is a cop-out. If you were caring for patient A with pneumonia and patient B came in having an acute myocardial infarction, would you be too busy to go treat B?

Some excuse themselves with, who am I to fix a sick system? I’m just a doctor or nurse.I take care of patients. Sick Healthcare is a matter for politicians, not me.

The best response is twofold. First, Healthcare is sick. Yes, it is a system rather than a human, but systems thinking – the cure for sick systems – is virtually identical to the practice of good medicine. Who better to do that than a good doctor? Second, carefully consider what the Congressional doctors have with/to the Patient so far. Do you still think they are the right people to fix healthcare?

Some give the tired excuse that one person cannot do anything. Try that one on the Duke of Wellington, Adolf Schicklgruber (aka Hitler), Mao Tze Dung, or Li Kwan Yu.

It takes only few persons with passion to start a world-changing revolution. Recall your American history and think about Thomas Jefferson and Benjamin Rush, one of the five physicians among 56 signatories to the Declaration of Independence.

Finally, there are our colleagues who emulate the ostrich. They claim that PPAHCA (Patient Protection and Affordable Health Care Act of 2010) is a start and is better than nothing. While Congress is adept at disingenuous naming of Acts they pass, PPAHCA may be a new low (or high, depending on your viewpoint). It does not protect patients; it is the antithesis of affordable; and it cannot provide CARE. Only nurses, doctors, and allied health personnel can do that.

To providers who think PPAHCA is a move in the right direction, I ask the following. Would it be “at least a start,” if I gave a drug that raises intracranial pressure to a patient with incapacitating headaches? True, I have no idea what is causing the headaches (no etiologic diagnosis). True, I have no evidence that something that raises intracranial pressure cures headaches. Indeed, raising intracranial pressure in patients whose pressure is already high may kill them, but hell, ‘at least it’s a start.’

If we providers are true to our oath to heal those who are sick, then we must raise our eyes and take up the case of Patient Healthcare. If we do not, Patient Healthcare will surely die and along with him goes both our patients and ourselves.

Before discussing what we need to do to practice good medicine on Patient Healthcare in Part IV, I need to answer a question that I hear over and over, a question many of you have asked yourselves. How did my calling turn in to a job (Part III)?

Deane Waldman, MD MBA, author of “Uproot U.S. Healthcare,” your doctors’ guide to curing Patient Healthcare.

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