A House Divided

If you put ten physicians in a room, you will get nine different opinions.  It doesn't matter if you are discussing policy, diagnostics, or politics.  Indeed, medical training develops deep independent thinking. We often feel alone in the care of our patients, we picture ourselves the sole barrier between illness and well being.   We battle our fellow physicians, administrators, and insurers.  You can argue the pros and cons of siloed thinking, but there is no denying the reality of the barriers that we have built around ourselves.  One wonders if a house divided against itself can continue to stand.

There is no doubt that the external threats to the stability of this profession are growing by the minute.  Politicians wrangle to define quality and best practices.  Allied health professions push to expand scope. Lawyers fight to police a group that is reluctant to police itself.  The alphabet soup grows in scary and threatening ways: ACA, ACO, MU, MU2, HCAPS, etc, etc, etc.  As our heads spin in dizzying circles, the physician voice fades into the background.  Nay, it is absent.

We criticize ourselves, we disagree, we reproach our own louder than all those silly little voices that encroach on our freedoms by and by.  This is who we are.  We rarely agree.  In some ways, I believe this is our greatest strength.  We are not afraid of infighting.  

Our own disorderliness, while internally nourishing, proves impotent when faced with external threat.  We are lousy mobilizers.  As much as we fight for our patients, we are poor defenders of ourselves.  

The battle lines have been set, and I believe time grows short.  The window to effect policy will only be open for so long. The practicing clinician, those wading through the mud of actual care, can and must have their voice be heard.  We cannot do this, however, if our words continue to be so glaringly disparate.

A common ground must be illuminated to the masses.  I suspect our failing point in the past was biting off far more than we could chew.  We picked the largest most contentious issues.  It's time we chose a more narrow focus point:

Meaningful use
Maintenance of Certification
Face to Face visits for home health
SGR

I am fairly certain that ninety percent of practicing clinicians (not administrators, health care policy wonks, or non practicing MDs) can agree on these issues.  

They need to be abolished.

Can we find a way to work together on this?