Former ACC President Ralph Brindis, MD, MACC, during his
presidency frequently discussed the portrayal of physicians as knights, knaves
and pawns, following the publication of a piece in JAMA on the topic.
In their commentary, Sachin Jain, MD, MBA, and Christine K. Cassel, MD, argue
that physicians are portrayed as being “motivated by virtue (knights) or rigid self-interest (knaves) or … [as] passive victims
of their circumstances (pawns).” This is
important because a “society's view of human motivation influences whether it
builds public policies that are permissive, punitive or prescriptive.”
This discussion theme continues on the KevinMD
blog, where Kevin Pho, MD, discusses the “underlying tension between
physicians and health policy experts.” He writes: “Health policy experts take
subtle jibes against physicians in their analysis,” effectively treating
physicians as the “knaves” mentioned by Jain & Cassel, and thus recommending
policies that are punitive. However, Pho notes that physicians are hardly
innocent in this debate, as “doctors generally discount [health policy
experts’] opinions because they haven’t gone through the rigors of physician
training.”
Pho goes on to say that doctors need to be involved because
they have the trust of patients, as shown by a 2009 Gallup poll that found
physicians have the highest level of public trust on health care reform. The
ACC conducted a public
survey in 2008 and found similar results. Because of this, Pho writes, “it
baffles me when policy experts don’t give doctors many olive branches when
making their health reform arguments.”
I agree. Efforts to make changes to the health system would
go along a lot smoother if health policy “experts” attempted to obtain the
support of physicians. It’s short-sighted to address the health insurance
system, which arguably was the hardest hit by the Affordable Care Act, without
addressing the physician payment system. There’s so much that needs improvement
in our current health care system, and physicians have first-hand experience
with much of it. Health policy experts might be better able to craft solutions
if they stopped viewing physicians as “knaves” and started seeking our support.
Together, we can improve the health care system in a way that both reduces
costs and improves patient care.
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