The Doctor Is Out

EMAILS FROM THE DESERT by Edgar Gamboa, MD, FACS | SAN DIEGO, 9/25/09 -- In the increasingly complicated discussion about health care reform, every legislator and economist seem to suddenly possess a comprehensive knowledge of what is ailing the health care system in the United States.

Everyone – from the corridors of the White House and halls of Congress to newsrooms and TV stations across the nation – knows how to treat this malady. Why is health care in the US getting financially out of control and draining up to 16% of the GNP? Why are 40 million citizens uninsured? Why is the most affluent nation in the world ranked 29th worldwide in infant mortality?

Many solutions have been proposed: a public health option, insurance portability, mandatory coverage of pre-existing disease, tort reform and caps on malpractice award, affordability of formulary drugs, $1.2 trillion stimulus, emphasis on physical fitness and preventive health programs, etc. Criticisms abound as well: health benefits rationing, facilitation of euthanasia or death panels, unrestricted federal funding of abortion, socialized medicine, governmental dominance of the health care industry, stifling of medical research and innovation, elimination of conscience clause for pro-life physicians, etc.

In this raging debate, one important voice has not been listened to. The art and science of medicine rests, in essence, on the relationship between the patient and the doctor, between the one who is sick and the one who, by knowledge and experience gained through years of clinical training and practice, cures that sickness. Everything else revolves around this unique interaction between two human beings.

Yet, in the attempt to improve health care today, albeit well intentioned, the physician has been brushed aside, if not maligned. The politician is in. The doctor is out.

One surgeon addresses this matter in a September 17th letter to President Obama. I quote Dr. Richard Armstrong's letter in its entirety below:

September 17, 2009 


President Barack Obama 


The White House 


1600 Pennsylvania Avenue NW 


Washington, DC 20500 



Mr. President, 



I have followed the health reform debate closely from its beginning. In many ways, I have followed this since the beginning of my career in medicine 33 years ago. In your speech to Congress last week you said that the time for bickering should be over and we should get down to the real work of fixing the problems. I agree with you. 

I have read HR3200 and the proposed bill from the Senate finance committee. I must tell you, Mr. President, that these proposed pieces of legislation will not fix the problems. Each of these or a compromise of the two will do nothing but add to the cost, the bureaucracy and the waste that you have said repeatedly that you want to reduce. 

Although you have stated that we should keep what works and fix what doesn’t, the reality is that it is our systems of health care delivery, organization of government programs and the insurance industry that represent the true issues. These aren’t working for Americans and are at the heart of the issue. Massive new government intervention, billions of dollars of new government spending and regulation will not solve these problems. The problems will only be multiplied and it will be more difficult for physicians and patients to navigate an already overly cumbersome system. 

America has the most advanced health care in the world. Although many of the advances in medicine and medical science have benefited from the financial support of the government, it is not the government bureaucracy that is responsible for how far we have come. The success lies with the individual physicians and scientists whose passion for the truth, for solving complex problems and for persisting until they are solved, has given us what we can be proud of as a nation, excellence. 

The majority of physicians in this country are driven each day by the desire to provide excellent care to each patient they see. Doctors do not begin their days thinking about the joy they will receive from navigating the morass of insurance and government regulations that have become so entrenched in our daily lives. The joy comes from our work, one patient at a time, one problem at a time. The joy comes from a job well done and America’s patients benefit. 

We have not, as a group, been engaged in a meaningful conversation with the administration or congress about solving the difficult issues of providing health care for all Americans while maintaining quality and integrity. We are a deep well of experience, wisdom and talent. We are willing to come to the table. 

Yes, American medicine is fragmented. We are not represented by one uniform society. Less than 15% of us belong to the AMA and yet the media and your administration continue to speak as if the AMA speaks for all of us. It does not. Although its member physicians have made tremendous contributions to medical advances and patient care, the corporate organization of the AMA is a part of the problem, not a part of the solution. 

This physician’s organization, Sermo, has outlined some basic ideas and ways to begin the discussion in our Open Letter and the Physician’s Appeal. You have the podium, Mr. President. You have the ability to slow this legislative freight train down before it pulls us off a cliff that will damage our ability to provide excellent care to America’s citizens, not improve it. 

Personally, I have no political agenda. I am deeply concerned about the course you are taking. I implore you to take the time to meet with working physicians of America. I implore you to listen carefully for it is the healthcare professionals that have made medicine in America the best in the world, not the government. We can help you move this forward constructively. Please give us that opportunity. 



Sincerely, 





Richard A. Armstrong MD FACS





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