To serve patients and the profession, more physicians should be lawmakers

Regarding "Can unions lead to better patient care?" (Column, Aug. 6): I want to thank Paul S. Mueller, MD, MPH, for his Ethics Forum comments. I commend his perspective and agree that in the best situation, doctors would take a driver's seat in leadership and advocacy efforts to improve conditions for both themselves and their patients. I also support the notion that the majority of physicians who are in this country would support most, if not all, of his recommendations.

Despite the verbal and written support, though, I think we fall far short of actually taking on these roles at any significant level. In my opinion, I think too few physicians take on these important roles actually required to change the system.

For instance, proportionately few physicians serve in legislative roles at the state or federal levels of the respective House of Representatives or Senate. It seems contradictory that (perhaps) most physicians recognize the need for active physician leadership, though so few follow through.

Perhaps physicians don't get involved in these capacities because of the fear of stepping into unknown roles? The lack of training in these positions? The interest to take care of people one-on-one only?

To be fair to our colleagues, we typically don't go premed expecting to politic in government. However, do we, as a profession, not realize that the importance of improving health care at a system level can be just as significant as developing or improving the latest treatment for a particular disease? Regardless of why physicians do not stand up for themselves and their patients, it does not change the fact that physicians don't stand up.

I think it would be helpful to first answer the question: What motivates us to care for our patients at the bedside and not write the laws responsible for maintaining that same patient care at the bedside? In parallel, we need to develop viable, effective solutions as soon as possible to prevent the system from corroding further.

I agree that we must continue to put the patient above all else to maintain the highest level of professionalism and care. However, I argue that other stakeholders may not put the patient above the bottom line. As a result, if we knowingly do not act to defend our patients from inadequate legislation or dangerous insurance policies, are we not putting patient care at risk?

If we allow others (nonphysicians) to dictate to us how to run our practices in any capacity, are we also not putting patient care at risk? Thus, are we truly acting in the most professional way if our sole approach to change is partially effective advocacy and we otherwise continue to take a backseat as a profession to corporate and legislative mishandling?

Whenever we prescribe a treatment for a patient, we evaluate the risk/benefit for that patient. If we use business techniques such as developing a physician union, is the risk still greater than the benefit?

Brad C. Klein, MD, Bryn Mawr, Pa.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2007/08/27/edlt0827.htm.