v4n4 - Doctors Get Involved

Doctors are making House calls. And Senate calls, too. Frustrated by the problems they see in the nation’s healthcare system, they’re joining with patient advocates to call for reform.

Dean Gesme, MD, an oncologist at Iowa Cancer Care in Cedar Rapids, is one of these medical activists. A past chairman of the National Coalition for Cancer Survivorship, Dr. Gesme has grown increasingly frustrated at the inequities and inefficiencies in the care provided to cancer patients. For example, he’s a believer in educating patients—taking 20 extra minutes to talk to a patient about his or her kind of cancer, asking a nurse to spend an hour with a patient prior to the first chemotherapy infusion, discussing side effects and ways to cope. Yet Medicare does not pay for patient education. So “the incentive isn’t there to do it,” he says. “The bottom line is I get paid the same amount if I don’t.”

Tag-team lobbying, he has found, sends the message that the quality of cancer care needs to be improved. The cancer survivor tells a personal story and the doctor provides in-depth information on healthcare issues. This collaborative effort is educational for doctors as well. “Working with patient advocates keeps me better grounded in quality-of-life issues,” Dr. Gesme explains—everything from the burden of out-of-pocket expenses to the difficulty of holding a job during treatment.

Unfortunately, the politicians he has met are often “suspicious” of working with physicians. The root of the problem, he believes, is money. The government’s goal is to contain costs; meanwhile, legislators typically think doctors are seeking to boost their income. One solution is to add a nurse to the lobbying team. “They aren’t viewed by staffers and others on Capitol Hill as quite so ‘tainted,’ if you will,” he says.

Dr. Gesme admits doctors as well as legislators need an attitude adjustment. “I’ll be the first to say there’s a lot of pressures on Congress that I don’t fully understand,” he says. “I need to be a little more open and a little less defensive.”

To other doctors joining the effort, he recommends humility. Working with patient advocates, you’re bound to hear stories about the best—and worst—doctors they’ve encountered. “Have a thick skin,” he counsels. “And put your guard down.” The result can be beneficial not just for legislative efforts but also for the doctor-patient relationship. By entering a new sort of partnership, he says, doctors can gain a keener sense of what patients need from the healthcare system.