Some doctors strive to remain apolitical with their patients. I was moved to give a speech during the most intense election in American history.
As we approach the finish line of perhaps the most consequential and most controversial presidential election in American history, I am reminded of Tip O’Neill, who famously said, “All politics is local.”
The late Massachusetts politician and former Speaker of the House believed that what mattered most to people was not grand philosophical debates about the size of government, fiscal policy, or the role of the United States in world affairs. Ta. What really matters to voters is what’s happening around them.
During this election cycle, many of these “table” issues have to do with health. People are concerned about access to insurance, purchasing medicines, and restoring reproductive rights. They worry about going bankrupt if they need hospitalization, whether they will be able to care for their aging parents, and whether they will be able to find a health care provider who will take their insurance. Gun violence has a unique impact on our nation and afflicts our schools. These are existential questions for too many people in the United States, and they should be important to us as physicians, too.
Some doctors try to stay out of politics. However, the American Medical Association does not prevent doctors from expressing political views. The AMA Code of Medical Ethics states: Lobbying on behalf of a political position, party, or candidate. and to exercise our political rights as citizens to the fullest in all other ways. ”
Over the past decade, I have become increasingly involved in the intersection of medicine and politics. I’ve drafted legislation, lobbied on Capitol Hill, testified before Congressional committees, written various editorials, and served as a medical analyst on television.
I also work in Washington, DC, a city with large socioeconomic and health care disparities. This is a place where politics is woven into everyday life. I treat both insured and uninsured people. Members of Congress receive primary care from the U.S. Capitol’s primary care physician’s office (the most exclusive concierge service in the country), as well as DC Medicaid enrollees who often rely on city clinics and emergency rooms for primary care. I’ll see you. Some patients in my practice have their medications delivered to their homes, while others rely on an unreliable supply of collected drug samples. I have worked with homeless people whose prescriptions were stolen from night shelters.
Recently, I treated a patient who had a major myocardial infarction while visiting DC from another state. He was ill when he arrived and underwent the typical series of aggressive emergency interventions and medical treatments that have revolutionized cardiovascular medicine over the past 20 years. He was immediately taken to the catheterization lab, where the blocked coronary artery was reopened and a stent was placed. He required invasive hemodynamic monitoring and hobbled on the limits of mechanical support for several days. He eventually recovered and gradually tolerated medical therapy based on modern guidelines. We started planning our discharge.
There was just one problem. He had no insurance. He didn’t have insurance, so he couldn’t afford the drugs (without insurance, Entrest costs about $700 a month and Jardiance costs about $600). Without insurance, it would be nearly impossible for patients to see a cardiologist who specializes in advanced heart failure at home, and without insurance, patients would be left without a defibrillator if they needed one. I have no choice but to do it. Fortunately, he is likely to survive the almost catastrophic event, but he will almost certainly go bankrupt.
It doesn’t have to be this way.
For too long, doctors have believed that our health care system is broken, that EMR charts have replaced patient care, that our reimbursement system encourages quantity over quality; Patients have been vocal about suffering the consequences. But when the country’s politics affect their patients, many American doctors remain silent in public and in their clinics.
The issues facing patients are now irrevocably politicized and polarized. 27 million Americans are still uninsured, serious illnesses often leave people with unpayable debt, and 29% of women live in states where abortion is unavailable or severely restricted. In many cases, they cannot afford medicine. We also live in a time of mass misinformation, where prominent people openly deny science.
During a recent visit to her clinic, she encouraged a vaccine-skeptic patient to get a COVID-19 booster shot, but she just laughed and waved back. After the visit, she sent me a note from the EMR portal and an article claiming that the COVID-19 vaccine has killed more than 1 million Americans. I told her again why I thought she was wrong and why vaccines could protect her from severe disease. She remained unconvinced. I will continue to do my best.
The conversations we have with patients are not abstract, but brutally real. Almost every week, patients tell me they are having trouble obtaining one or more of their medications. A breakthrough drug isn’t a breakthrough if patients can’t afford it. Not long ago, a lawmaker who was thrilled with the rapid drop in LDL he saw after starting a PCSK9 inhibitor was forced to stop taking the medication every six months because of his insurance when the recommended list of prescription drugs changed. was dissatisfied with having to change the . The discussion about pharmacy benefit managers suddenly becomes less esoteric when it comes to your own medications.
When doctors publicly advocate for change, we are often told to mind our own business. In 2018, the National Rifle Association tweeted: “Someone should tell these arrogant, anti-gun doctors to stay in their lane.” Fred Guttenberg, whose 14-year-old daughter Jaime was killed at Parkland High School in 2018, said: “I want to thank the doctors for honestly explaining how the AR-15 bullet destroyed my daughter’s body.” The truth hurts sometimes.”
I believe that physicians must be active communicators of the truth, and that the dialogue begins in the clinic.
The American College of Cardiology warns us: “Cardiovascular disease is the number one cause of death in the United States and a leading driver of health care costs. We own the problem. We must own the solution.”
We have a lot of work to do. Let’s talk about it.
Off Script is a first-person blog written by a leading expert in the field of cardiology. It does not reflect the editorial position of TCTMD.
