Your doctor's exam room is getting overcrowded. Modern U.S. health care means that, like it or not, you and your physician are sharing that once private space with an insurance executive constantly hissing in your doctor's ears to move it along. You are also sharing it with pharmaceutical marketers, lobbyists from the food industry... special interest groups of every stripe.
Now move over and make room for one more interested party: your employer.
Ever since the HHS ruling last month that employers cannot exclude contraception from the preventive services that their insurance plan covers, the country has worked itself up into a fever of self-righteous indignation, framing the controversy around women's rights and religious freedom, and magnifying it with political posturing. As a doctor, I see it through a different lens. I see the primary symptom of our dysfunctional health care system as being the unrelenting erosion of the doctor-patient relationship -- a relationship that is central to health and healing. And I see this latest distraction from meaningful health care reform -- an employer's wish to define what kinds of access to health care are appropriate for his employees -- as just one more assault on that very intimate and healing dynamic. Now, in addition to trying to shut out the noise from all the parties that want to make a profit from your visit, doctors now have to consider: "So what does your employer think of all this?"
How many more parties are we willing to invite into the therapeutic conversations we have with our health care professionals? If a CEO of a major company is an anti-vaccine activist, can she refuse to let her company's health plan cover routine immunizations for children, as a matter of conscience? Could an animal rights organization like PETA refuse to allow coverage of chemotherapy regimens that relied on animal research, based on that group's deeply held convictions? This week the governor of Virginia called for legislation that would require women to have vaginal ultrasounds before undergoing an abortion. It used to be that you had to go to medical school before ordering an invasive medical test; now apparently all you need is political ambition and a microphone. In our current divisive political climate, the conversation about our health care has become less and less about what is happening between doctor and patient, and more about what individuals or groups want for themselves -- and don't want for the rest of us.
We will know that our health care system is functioning well when the one overriding question that drowns out all the other noise in any doctor-patient encounter is this: What is best for my patient? We can measure our health care system -- and our society as a whole -- by how hard we make it for health professionals to ask and answer that fundamental question, whether it be due to punitive financial pressure, marketing strategies or political agendas. Cost effective health care can only result from sound health policy. The role of political leaders is to recognize and implement sound policy, not define it. Meaningful health care reform will require that all the self-serving noisemakers, from pandering politicians to profiteers, and yes, even people of deeply felt but not widely held convictions, get out and stay out of the exam room. If we fail to do this, the doctor and the patient will end up having the smallest voices in the room.
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