Physicians Must Lead Way to Health Care Reform

When it comes to the U.S. health care system, "we have multiple organ failure," said former U.S. Surgeon General Joycelyn Elders, M.D., during a recent meeting here. And in terms of how physicians have responded to America's growing health care crisis, Elders added, "we have not been great leaders."

Elders, a professor emeritus at the University of Arkansas Medical Center in Little Rock, said she was disappointed with how physicians have dealt with the health care crisis. America's physicians need to develop leadership strategies, she said at a May 1 plenary session during the Academy's 2008 National Conference of Special Constituencies and Annual Leadership Forum.

According to Elders, physicians must address the inadequacies in the system. "If you've got 10 holes and plug up nine, you've still got a leaky dike," she said. Educating and empowering patients to take better care of themselves would be a good place to start, said Elders, adding, "(then) we've got to have universal access to health care because we're spending a lot of money and not improving the health of our nation." She pointed out that in the United States, every criminal has a right to a lawyer, "but we don't feel that every sick baby has a right to a doctor."

Elders stressed, however, that health care is bigger than any one physician, and no one physician can do it all. "I felt the energy in the room this morning," said Elders, referring to the morning's opening session. "If we could harness the energy of 750,000 doctors across the country, we could build a health care system that we're proud of."

The United States has "the best doctors in the world, the best nurses in the world and the best hospitals in the world," said Elders. "But when we start talking about our health care system, how we take care of our people … and how the WHO (World Health Organization) rates us, I don't hear anybody talking about how great we are."

Elders wasted no time in ticking off the problems strangling the U.S. health care system, beginning with the 47 million people who lack health insurance. She also cited a shortage of primary care physicians, minority physicians and rural physicians.

In addition, physicians and their patients struggle to overcome cultural differences exacerbated by the more than 200 languages spoken in the United States, said Elders. The nation's minorities are more likely to be uninsured, obese and chronically ill, she said, adding that physicians treating minority patients have trouble meeting quality performance standards because of poor patient compliance.

Elders also cited an aging population and health illiteracy as additional strains on America's health care system. "It's harder to take care of a less-educated, poor patient," she said.

The former surgeon general acknowledged that the United States has yet to stem the tide of inequality in the delivery of health care. "Nobody in this room will say we don't have health care disparities," said Elders, adding that such disparity goes hand-in-hand with a lower socioeconomic status. She chided an educational system that serves millions of school lunches every day but often cuts nutrition and physical education classes from school curricula.

Elders challenged her physician colleagues to take action. "Listen, learn and lead," she urged. The U.S. health care system needs changes that are "prevention-focused, purpose-driven and solution-oriented," she added, calling for a revamped system that would provide a uniform standard of accessible and affordable care for all people.

"We doctors haven't gotten into a room and fought until we're bloody. We need to have a message and then be able to articulate that message accurately, clearly and with purpose," said Elders. "We've tinkered around the edge … we've been arranging the furniture in the living room. It may be time to build a new house."

Elders left her audience to ponder this closing thought about America's broken health care system. "Not to know is bad; not to want to know is worse. Not to hope is unthinkable. But for us not to care is absolutely unforgivable."