The following is the final article in a series of ten that originally appeared in the Indiana Medical Society’s monthly magazine “The Bulletin.” As President of the Indiana Medical Society over the past year, Dr. McGoff wrote on a wide variety of topics, most importantly the current condition of health care in the United States. These articles will help illustrate Dr. McGoff’s views and beliefs. This article appeared in the August 2009 issue.

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“The good physician treats the disease; the great physician treats the patient who has the disease.”- William Osler, MD

For the last few months health care has take center stage in a national debate. In June President Obama went to Chicago to address the AMA about his vision for how to improve the health and well being of our great nation. He was treated with respect and after speaking to members of the Indiana delegation who were present, there was mostly applause, but a few jeers especially when he backtracked on tort reform for physicians.

As this is my last article as President of the Indianapolis Medical Society, I thought I would reflect a little on the state of medicine and the importance of physicians in the upcoming debate. I believe that we are the most important cog in the wheel of health care policy and I say that not just because I happen to practice medicine for my livelihood. Let’s be honest, every single transaction in health care requires a physician’s involvement.

Take for example the hospitalized patient. If you want to admit a patient, they have to be seen by a doctor and have an order written. Once the patient arrives, every part of that patient’s day requires a physician order: what they eat, if they can get out of bed by themselves, how they go to the bathroom and when they get to leave. These are the easy decisions, and not the ones that most affect the cost of health care. The big-ticket items are also completely controlled by physicians: the medicines we prescribe, labs and x-rays, or any procedures/operations. This is “where the rubber meets the road” and the true power that all physicians have over the costs of taking care of patients. The same holds true for ambulatory and outpatient visits.

Much has been noted about the research at Dartmouth regarding the variability in costs and outcomes around the country. A recent article, “The Cost Conundrum,” in The New Yorker by Atul Gawande has gained national attention. He looked at two towns in Texas and the disparities in the amount spent and their outcomes. Surprise, just because you spent more money, it did not equate with a better result. “In fact, the primary cause of one community’s extreme costs was, very simply, the across-the-board overuse of medicine.”

There are many half-truths and myths being thrown out as gospel. Many pundits have stated that most are unhappy with their current health plan. However, a recent CNN poll showed that 85% of those polled were quite satisfied with their coverage. Are we going to fundamentally restructure American health care for the other 15%?

Another stipulation is that we need this new government plan to offer more competition and patient choice. Currently there are over 1,500 private plans in America. The addition of another government payor, ala Medicare/Medicaid would be disastrous. As an emergency physician, 50% of my patients already fall into that category. Their fee schedules haven’t even covered the cost of inflation for more than a decade and the amount of paperwork required is an additional burden.

I believe that no one should go bankrupt in America because of a lack of health insurance. We need to ensure that an affordable catastrophic policy is universally available. However, just as your car insurance doesn’t cover your gasoline or oil changes, individuals need to take responsibility for most of their day-to-day health care outlays.

As I reflect on my year as your President, we have made some headway, but still have lots of work to do. I hope that you still feel your membership to the Indianapolis Medical Society is a good value. We have worked to develop a digital society and during the H1N1 flu pandemic, we were able to assist the Marion County Health Department spread the word quickly by email about the best way to effectively take care of our patients. Project Health continues to do great work and I am thankful for all of the physicians who have generously donated their time and talents to this organization. We have a beautifully renovated headquarters that will last us for the next generation of members.

It has been an honor and pleasure to serve you. Medicine still is an art and a true noble calling. While the turmoil and strife swirl around us with all the changes occurring, we must continue to be an integral part of the solution. As Osler said, “Let’s be great physicians and provide the best care possible for our patients.”