The basic building block of the U.S. healthcare system is the patient-physician relationship. It always was and always will be the basis of care. Health care doesn’t occur or progress without understanding and respecting this relationship.

No healthcare system, administrator, insurance company, nonclinical issue, or media perception should ever come between the patient and his or her physician. When a health emergency occurs—whether on a plane or in a crowded store—no one ever calls for a hospital administrator, trial lawyer, or insurance executive.

For too long, we have allowed ourselves to be idle bystanders as the healthcare system and the environment in which we practice changed. Too many physicians I know spend hundreds of unproductive hours complaining or preaching to the choir, without actually doing anything to change things.

My visits to our nation’s capital—as well as to my state capital (Harrisburg, Pa.)—have increased my awareness of this dilemma. Legislators pass laws based on anecdotal, incidental, and inconsistent data, while we struggle to be objective, identify and define the problem, and base care on the best evidence available.

Our legislators, media, and policy experts tell us how medicine will be, even though they have no understanding of the impact (time, cost, and obstacles) of the regulations and paperwork they impose, much of which is often of little clinical value. We’ve become peripheral to their decision making.

Stewards of our profession
The irony is that we as physicians are central to making the system work and are responsible for delivering care and dealing with any complications that arise. We understand where the costs and drivers are. In the legislative arena, where there is little leadership and less objective input, physicians have a great opportunity. But to shape the future of health care and its impact on the overall economy, we must step up, as difficult as that seems at times.

How can we all be advocates in stewarding our profession? My recommendations are based on discussions I have had with businessmen, my nearly 40 years of experience in medicine, and my personal history of growing up in the 1960s and 1970s.

We can begin by supporting the Orthopaedic Political Action Committee (Orthopaedic PAC). This is an easy, direct way to help ensure that the voice of orthopaedics is heard. Our past president, Stuart L. Weinstein, MD, who now chairs the Orthopaedic PAC, is a tireless advocate on our behalf. In this election year, a contribution to the PAC is especially important—and effective.

We can participate in Project 535. This initiative by the American Association of Orthopaedic Surgeons aims to connect every member of Congress (100 senators and 435 representatives) with an orthopaedic surgeon in his or her district. If you meet and get to know your legislators, you’ll find that they will value your input, especially in quiet times.

We can directly contribute to, develop relationships with, and support legislators at all levels of government (local, state, and federal) who support medicine, the patient-physician relationship, and common-sense, cost-effective approaches to improving the healthcare delivery system. So much of what affects physicians and patients is legislated at the state level; do not forget to foster local contacts.

Local involvement is key
We can get to know the members of our local hospital boards, our community leaders, and other stakeholders. We can develop strategies to educate these stakeholders (the solution to most of our problems is education). Most importantly, we can educate our patients on evolving issues as appropriate; they value our thoughts and often will support actions that improve our healthcare system. We can take time out of our busy days and step back to take a broad look at the various factors affecting our practices. We can try to see the various points of view and to frame our responses to these policies.

We can build relations with the media. We have important stories to tell; as storytellers, representatives of the media will be interested in what we have to say, especially if we frame it properly. For example, the following ideas may resonate with media representatives:

• Medical
• Online

Medical practices are small businesses that contribute to the local economy, hire workers, and enable people to continue working.

Orthopaedists perform surgeries that get people back to work, let kids continue to play sports, keep the elderly in their homes.

We can work to bring physicians from other specialties together in a team that understands the need for broad support to make our profession stronger. Most legislators and decision makers tell me that medicine is fragmented as a profession and various specialties often contradict each other.

This also presents a great opportunity for cost savings. It is time to begin to deal with payers more firmly and confidently with shared goals across specialties.

Finally, we can get involved with our communities—coaching our kids’ teams, supporting local nonprofit organizations, contributing to local food banks and religious organizations, patronizing local businesses. We must make time to enjoy our family and friends. They stand by us. Their support is key.

As physicians, we have a responsibility to our patients, putting their quality care first. But we, as well as our patients, must understand the economic costs and other consequences of the decisions we jointly make. We, as well as our patients, must be involved in shaping our futures.

Herbert L. Kunkle Jr, MD, is a member of the AAOS Advocacy Resource Committee. He is in private practice in Eastern Pennsylvania.