Affordable Care Act Healthcare and Politics

Should Clinicians Communicate with their Patients About Health Policy Issues?

In this contentious political environment where proposed legislation could dramatically alter the existing healthcare landscape, you may have wondered whether or not healthcare organizations and physicians should speak their minds. Policy issues being debated (or not debated) could impact the lives of millions, and many Americans are not aware of the ways in which proposed legislation could impact them. Remember, many of them are the same people who claim to support the Affordable Care Act but do not support “Obamacare.” Understandably, many lack a full understanding of the healthcare issues being debated.

My colleague, Dr. Jerry Avorn of Harvard Medical School – Division of Pharmacoepidemiology and Pharmacoeconomics, recently contributed an op-ed piece to the December online issue of JAMA. The article is titled “Engaging With Patients on Health Policy Changes: An Urgent Issue.” It appears in JAMA’s online issue, published December 8, 2017.

Here’s the central question Dr. Avorn takes on within his article:

“Many of us have taken stands on health policy questions as individuals or collectively in groups, but one question has remained contentious: Should clinicians interact with their own patients about health policy debates whose outcome could sharply affect their care? Or should we remain mute on that front, defining the patient-physician relationship much more narrowly as being restricted to making diagnoses and prescribing treatments? Supporters of the latter view point to the impossibly short amounts of time available for most clinical encounters or suggest that addressing patients in their roles as citizens, or “talking politics” to them, crosses an important line and is not an appropriate arena for clinicians to enter.” (Source: JAMA online, December 8, 2017)

ln his article, Dr. Avorn goes on to say that “A strong case can be made that rather than being a taboo subject, discussing transformational changes in health care coverage with patients could be seen as a core responsibility of all clinicians—physicians, nurses, pharmacists, therapists. This is not simply a moral issue; it is necessary to ensure the capacity of health care professionals to continue to provide patients with the health care they seek from us. The intimate connection between coverage and clinical care also offers a direct and unassailable way to communicate this information.” (Source: JAMA online, December 8, 2017)

Dr. Avorn implores healthcare professionals to reach out to patients and friends in a last-minute attempt to educate them about the consequences of these imminent changes to the way we fund health care for some of the poorest among us.  In an email to me, he asked that I please consider forwarding this widely to my network of colleagues. And then he went on to say that “the battle isn’t quite over; greater awareness by the public of these sweeping but poorly understood changes could have an impact on how the nation views its options in the pivotal next few days and weeks.  The odds are steep and time is very short, but all is not lost just yet.  Each of us must do what we can.”

I love Dr. Avorn’s passion and commitment to making sure that the poorest among us have access to affordable health care. Perhaps the most moving and poignant point in his article was when he stated that “As physicians, we should reaffirm our role as human professionals who have intimate relationships with—and responsibilities to—our patients. Even a modest attempt at such an intervention could have a substantial multiplier effect on national policy choices.” (Source: JAMA online, December 8, 2017)

Whatever your political persuasion, I recommend you check out Dr. Avorn’s article and give his position some consideration.

About Dr. Jerry Avorn

Jerry Avorn, MD, is a Professor of Medicine at Harvard Medical School and Chief of the Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women’s Hospital. An internist, geriatrician, and drug epidemiologist, he studies the intended and adverse effects of prescription drugs, physician prescribing practices, and medication policy.

His major areas of research include: the scientific, policy, and social factors that shape physicians’ drug choices; the identification and prevention of adverse drug effects; medication compliance by patients; programs to improve the appropriateness of prescribing and drug taking; and pharmaceutical cost-effectiveness analysis. Dr. Avorn pioneered the “academic detailing” approach to continuing medical education, in which non-commercial, evidence-based information about drugs is provided to doctors through educational outreach programs run by public-sector sponsors. Such programs are now in use in the U.S., Canada, Australia, and Europe.

Dr. Avorn did his undergraduate training at Columbia University in 1969, received the M.D. from Harvard Medical School in 1974, and completed a residency in internal medicine at the Beth Israel Hospital in Boston. He has served as president of the International Society for Pharmaco-Epidemiology and is a member of the Institute of Medicine Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. Dr. Avorn is the author or co-author of over 275 papers in the medical literature on medication use and its outcomes, and is one of the most highly-cited researchers working in the area of medicine and the social sciences. His book, Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs, was published by Knopf in 2004 and is now in its tenth printing.

1 comment on “Should Clinicians Communicate with their Patients About Health Policy Issues?

  1. I think this opens an opportunity for discussion and education about the actual policies being debated rather than falling into politicians’ talking points. Plus, clinicians may bring a better understanding of what the policy will look like in action, in their patients’ lives.

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