April 4, 2012
Now seems an especially fine time to remind us of a story I've related before.
The story is from the Civil War, and involves President Abraham Lincoln and a visit he paid to one of the Union field hospitals. As Lincoln spoke with the doctors, one described a procedure that involved removing a soldier's arm at the joint. It had been a difficult operation, and the surgeon went to great length and into much technical detail while telling the story to the president and to several other physicians gathered.
As the doctors began asking the surgeon technical and procedural questions, Lincoln burst out with the one query he thought most needed answering, a question no doctor had asked: "But what about the soldier?"
I am reminded almost daily of that story, as health care and the proposals to change how it is managed in this country continue to make the news. Most recently, the U.S. Supreme Court heard arguments against President Obama's Affordable Care Act (ACA) from attorneys representing a coalition of states opposed to the law, while the U.S. government defended the proposal to the high court.
These discussions were highlighted by much legalese; volume upon volume of documents about the cost of care and its economic impact; complicated verbiage about who is covered when and why; constitutional concerns about mandated coverage for everyone; the role of the states in determining their health-care destiny; whether federal funds must be used as the federal government insists, or are at state discretion; whether the ACA falls apart if the individual mandate is removed from the law … the list of topics tangled up in the national health-care conversation seems nearly endless.
What's not being heard, not nearly enough, is the sound of Abraham Lincoln's voice rising above the cacophony to ask a simple question: "What about the soldier?"
Lincoln was not concerned about the technical merits of a successful surgical procedure, although he knew they were important. He did not consider the logistical challenges of dealing with a wounded man to be the only point of their discussion.
He wanted to know how the patient was doing.
So, too, must we.
As health professionals practicing in a culture of humanism and scientific excellence, our chief concern cannot be the nuances, subtle and otherwise, of health care legislation and the debate surrounding its legal and technical details. Our primary focus cannot be on the cost of everything, or how medical compensation rates are determined, or how health care reform might affect our taxes or insurance plans.
Are these issues important? Of course. To suggest otherwise is to be naïve, and would ignore all of the social, political, and economic forces at play on this issue.
But we must always put the patient - "the soldier" - first, above all else in the health-care discussion.
Whether the individual mandate is dropped from ACA means little to the man who is in pain from an untreated wound. The worried mother with two crying, coughing children could care less what effect "portability" will have on her. The septuagenarian battling skin cancer and arthritis does not wake up in the morning asking if attorneys have settled on the meaning of "conditional federal spending."
What these people need is care, and caring, from expertly trained healers like the ones emerging from WesternU's nine colleges. Should our mission also be to see that they are insured? Or should we be unconcerned as to whether they have health coverage or not, and simply care for them, help make them whole, and give them peace?
If the Affordable Care Act is thrown out by the Supreme Court, up to 50 million Americans who would have benefitted from its provisions will continue to be without health insurance. As has been noted before, a number that large is a statistic. On an individual and community level, however, it is a tragedy. Those who will not seek medical care - who will leave painful and even life-threatening conditions untreated, and who will not realize the lifelong benefit of preventive care and treatment across the health-care spectrum - are our brothers, sisters, neighbors, and friends. This issue is not about a disembodied "someone" we will never know. It is about the people down the street and around the corner. It is about us.
Whether one favors this legislation or not, it is incumbent upon us to not lose sight of the fact that in our role as health professionals, we must make every effort to bring health care to people. We must try to provide this regardless of our patients' resources and abilities, and do our utmost to improve their well-being.
We must always be able to answer, quickly and well, this question: "What about the patient?"
As always, I welcome your feedback on this topic and any others as we discuss WesternU's Benchmarks of Value, and our plans. Please e-mail me with your thoughts at firstname.lastname@example.org, and feel free to share this message with your family and friends.
My best to you all,