Who better knows how to fix a leak than a plumber?
Who better knows how to repair a cracked doorway than a carpenter?
Who better knows how to solve the conundrum of our leaking cracked health care system than a doctor?

Doctors are an important part of public discussions about health care reform.  Our prescriptions drive healthcare costs.  We are the crucial middlemen between the biomedical industry and patient health. Sharing our first hand experiences in health care delivery is an important part of first understanding where the problems lie, then second suggesting possible solutions to shape a healthier world.

We know, firsthand, what we need to more effectively, efficiently deliver care. (For me, an integrated medical records system where my clinic computer talks to the lab, to the hospitals, to the pharmacies, to specialists and emergency rooms so I can know what is happening with the health of my patients when they arrive with scattered fragments of histories.  “Oh, I had chest pain doctor, and I went to that hospital down south.  You know, the one in Indiana.  And they ran some tests and said something about how I’d need more tests, and told me to see a heart doctor, but I lost that number.  They also told me to see my primary care doctor, and so here I am. Oh, did you need those papers they gave me when I left the hospital?  I left them at home.”) We need interconnected health records.

We know, firsthand, where distortions in incentives are distorting the system. (For me, counting my productivity in the community health center by the number of patients I see in any given day, rather than the number of problems I solve, promoting delay in addressing non-critical problems, and forcing patients into multiple, potentially unnecessary repeat visits.  But how else do we ensure that the many many patients waiting to be seen will have the chance to be assessed for more critical problems? There is another, more global distortion—fee for service payments that promote bringing people in to be seen  by physicians who then do things to diagnose and treat disease rather than having a health care team endeavoring to keep people healthy.)

We need to shift payments away from fee for service and towards paying to keep people well. We know, firsthand, what socio-economic and environmental factors are impacting the health of the communities we serve. (For my patients, with the economic downturn, they have lost their jobs, and with them their health insurance, and therefore their doctors—I meet them when they turn to the community health center as a safety net provider in a society that links health care coverage with employment.)  We need health insurance for all.

I am going on four years past residency, and already in my short career I have worked in a dozen different hospitals, and scores of outpatient clinics (mostly in training, rotating through different hospital and clinic sites). I’ve participated in healthcare on the East Coast, on the West Coast, in Chicago, in Tennessee, in Central Africa, in rural Maine.  Inner city and suburban, rich and poor. I have seen, firsthand, the problems we need to address to create a healthier America.

As physicians, we are the experts in medical care delivery. We need to trust our insights gleaned by experience, and share our understanding to shape a healthier world, within our clinics, our departments, our institutions, our cities, and the nation. We are the insiders, the people who can best weigh in on how to forge together the moving parts of our  Frankenstein of a sick care system to create a functional medical system that supports health without bankrupting the nation.

Kohar Jones is a family physician who blogs at Progress Notes.

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