NCSC Keynote Speaker Challenges FPs to Advocate Change

"While you cannot do all the good the world needs, the world needs all the good you can do," said FP Eduardo Sanchez, M.D., M.P.H., quoting an anonymous source as he delivered the keynote address to an audience of family physicians and others at the National Conference of Special Constituencies, or NCSC, held here May 3-5.

In his address, Sanchez, who is director of the Institute for Health Policy at the University of Texas School of Public Health in Houston and chair of the National Commission on Prevention Priorities, encouraged family physicians to "agitate" for health care change with a common goal of "improving the health of our patients and our population."

"Frame a message, deliver a message that is concise and you can make a real difference," said Sanchez, a 2005 recipient of the AAFP Public Health Award. He added that NCSC is about bringing together people of different perspectives. Diversity is not about everyone having the same opinion on every issue, he said; instead, "it's about opening the table up and creating a safe place where people can put those issues on the table with a common objective."

Sanchez called it "shameful and saddening" that the United States has become a nation where education and income levels are likely predictors of chronic disease prevalence among certain populations. "It's shocking that the infant mortality rate is rising in southern states, and that the health care gap between whites and blacks is growing wider in the South," he said.

He cited a recent article in The New York Times that described a growing inverse relationship between diversity and charity. "Our willingness as an electorate to support public programs seems to decrease as the diversity of the population increases," Sanchez said.

Vowing to channel his anger and disbelief over such injustices into positive actions to effect change, Sanchez prodded his audience with a call to action: "The health of our population cannot improve overall if we don't tackle these issues."

He told audience members to begin their advocacy journeys by questioning their perceptions and examining their prejudices. "Admit, ask and analyze to make change in yourself," said Sanchez. "We shouldn't ask others to do things we're not contemplating or doing."

Sanchez called the U.S. health landscape "formidable," citing as reasons for that view some well-documented barriers in the health care system, such as the growing cost of health care, an "embarrassing" level of uninsurance and a spiraling burden of chronic disease.

He ticked off other factors contributing to that troubled outlook, including

"The uninsured tend to delay care or present in places that are more expensive and high tech than they need to be," said Sanchez. He illustrated his point by telling a story about a patient with no insurance who presented at a clinic Sanchez was staffing complaining of a blister on his foot. "The smell was enough to tell me I was dealing with more than a blister," said Sanchez. The ulcer required immediate hospitalization and amputation of two of the patient's toes. "Had he been diagnosed (with diabetes) and treated five years earlier with relatively low-cost medication, the cost of that care would have been less than the hospitalization and amputation," said Sanchez.

Spiraling costs for uncompensated hospital care -- as illustrated by that patient with diabetes -- result in higher hospital charges to paying customers, which, in turn raise health insurance premiums, Sanchez noted. Higher insurance rates cause employers to drop health care coverage to employees, which creates more uninsured patients, he said.

The best way to interrupt the spiral is to reduce the number of uninsured, said Sanchez, and a starting point from which to accomplish that goal is to increase enrollment in Medicaid, the State Children's Health Insurance Program, and other state and local government programs.

However, providing more insurance won't solve all the problems, cautioned Sanchez, because America's health care delivery system currently is not delivering the goods.

"Even those folks with insurance are not always getting what they pay for," said Sanchez. "If all we're going to do is invest in biomedical advances, we're going to miss the boat." Delivering better health care to the U.S. population "is not just about more medicine and more doctors," he said.

Sanchez encouraged physicians to take their understanding of the imbalances and injustices in the health care landscape and get involved in changing health care policy. He warned of four hurdles -- the "four Ps" -- that would have to be overcome in every advocacy battle:

"Leaders make mistakes; you'll make mistakes," said Sanchez. Forgive and move on, he urged.

"Think beyond the walls of your practice," Sanchez told family physicians. He encouraged them to stay informed, get engaged and take on leadership roles in their communities and organizations. Leadership is more than a title, said Sanchez, adding that successful leadership requires being able to