This is my column in October’s Emergency Medicine News:

When this is published, we could be on the way to a new healthcare system.  I don’t know what that will entail.  Few in the government really want my opinion.  That’s the way it is; we have limited power.  And yet, we have great power.

Last night, at work, I diagnosed a man near my age with new onset diabetes and osteomyelitis of the toe.  He was terrified, and fear radiated from his face.  He was afraid about diabetes, about neuropathy, about amputation.

We talked a while as I dealt with his blood glucose, then admitted him to the hospital for a surgeon to evaluate the affected foot and a hospitalist to control his diabetes.  He thanked me for smiling and being kind.  We shook hands and laughed before he went upstairs into his diabetic future.  He felt better.  He felt that someone cared, a bit, for his situation.

Reform or not, the one thing we can do as physicians is just that.  We can be competent and compassionate.  We can smile and touch.  We can do the right thing as long as government lets us.  (Pay attention to that thought, ‘as long as they let us.’  Store it away, and watch the future unfold).

I have been told, by some, that government-run health-care would be better than industry-driven health-care.  I have been told the opposite, as well.  Each side makes the argument that they will have greater accountability to the sick.  Advocates for government suggest that we, as citizens and employers of the government, can hold them to more rigid standards; can get what we want and need more effectively through the legislative process.  Those for the market believe that profit will always do a better job of driving customer satisfaction, efficiency and lower costs.  That profit and share-holder interests will make the market a better choice.

I have an idea about that.  I know what I think.  This isn’t the place for my comment on that.  What I do think is this.  The only direct accountability any patient can ultimately exercise is between care-giver and patient.  You can argue on the phone for weeks, and never speak to the right person at an insurance company. They can delay and evade for months.  You can also call your representative or favorite government functionary, each of whom works behind a shield of anonymity and distance, guarded by layers of voice-prompts on telephones, or the labyrinthine nature of mail-rooms and e-mail inboxes.  None of them are accountable the way we, the providers, are accountable.

And so, we have power. We can do what I did with my diabetic friend. We can touch and smile.  We can care.  We can do the right thing as much as possible.  We can show compassion, live compassion, feel compassion.  We entered medicine because, at least at some point in the past, we genuinely cared about the sick, the dying and the broken.  Our best hope for the future of medicine is to continue to do the same; or if lost, to rediscover what was driven from our hearts.

Our proximity to the sick is an advantage no one else possesses; and in truth, that no one else desires.  And our love for them is the most powerful weapon we have as we try to reform, or repair, or patch or whatever we call the machinations we are imposing on our system.

I don’t know what the future holds.  I hope it holds continued jobs, continued freedom and choice, continued competence in medicine.  I hope it involves amazing innovations and improvements in quality of life and the survival of human maladies.

But whatever it holds, good or bad, I do know the way to safeguard our place in the process, as physicians, nurses and others.  The solution for care-givers is, ironically, to give care!  If we give care, if we give love and concern, if we give of ourselves to those suffering, we will have far more power than any government functionary or insurance-company voice on the phone.

We may have our payments cut, our influence squashed, our opinions silenced.  But our compassion will continue to connect us, our love will continue to rebuild the broken and our concern for our patients will speak with a thunder no government or corporation can match.

Maybe, in the end, we can reassume control of healthcare.  And why not? We know it better than anyone else, because we know the sick better than anyone.  We touch them, treat them, listen to them, and even see them leave this life.  Those are powerful qualifications for leadership.

But we’ll never have control, ever again, if we give up the one velvet weapon we have, which is love for those charged to our care.  For ‘faith, hope and love abide these three, but the greatest of these is love.’

And it’s never more true than in the cathedral of medicine.

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