Some reasons why physicians are so meek in the public discourse of our health care system.

One problem is the disparate interests within the profession itself. Generalists and specialists each have competing goals, often at the expense of each other.

In any case, doctors need to take a front seat at the debate table. We can’t let those without front-line medical experience, like policy wonks, pharmaceuticals, insurers and the government, dictate reform.

One way to do this is joining with patients in framing our interests. Physicians by themselves are relatively weak lobbying force. But we will be heard when combined with a powerful voting bloc – for instance, seniors in the recent Medicare payment episode.