The Journey into health care

The journey into retirement means that one does not stop being a doctor, just that one's role as a doctor changes. Both KK and I have our commitment to servicing the difficult to treat. However, on another level, the time available during retirement affords one the opportunity to participate in areas of medicine that previously I was too busy to participate in. Namely, in the politics of medicine and the organized medicine role. The issues of preserving the intimacy of the doctor patient relationship, with the reality of who is going to pay for that relationship and its outcomes, requires a mindset and availability of time to devote to those issures. So, I have been on the "legislative committee" of our county and state medical society for years; interacting with state and national legislators regularly. Now, I have been asked to become one of the State House of Delegates at our State annual meeting. Essentially, this is a process of formulating policy and framing issues that will have national importance. In this era of the question of who is covered by health insurance, and what will it look like, seems to me to be an appropriate time for me to spend the time and effort to use my experiences and provide a framework within which such a debate can occur. I remember well when Hillary Clinton proposed a national health plan and then she proceeded to do the most expensive and least effective thing regarding her own father who had had a stroke and died after weeks in an intensive care unit on life support equipment. What was clear to me at that time, that she would do what other families did, leaving dear old dad in the ICU, on mechanical ventilator, until family members felt comfortable in "letting him go." Everything had been done inspite of clinical evidence that he was gone way before the "family" was willing to let go. There are many other instances where these decisions are relavent. Fully 80% of the health care dollars are spent on the last 6 months of life. What are we doing? Depriving adolescent girls of the Human Papiloma Virus vacination, which will save MILLIONS of women from cervical cancer, sterility, etc. and spending it on dear old dad at the terminal end of his life. The issues are out there. One does not have to go looking for them. These issues come up at the oddest of times and for many times obscure reasons; however, the issues come up, and being poised to address them requires slogging through the mundane and the "business of medicine" issues and being ready to address these more universal and holistic issues once they emerge. We will see what comes of this State meeting. Maybe something will be on the Presidential election 2008 agenda regarding universal health care coverage, or just a footnote in the history of medicine. In either case, I will make myself available for the debate; for, it is only when the groundswell of an issue comes to the fore, that those who are available can make a contribution.