THE AFFORDABLE CARE ACT - MY OPINION

In my careers, as a  health care attorney and as an hematologist caring for very sick people of all ages (I am retired from both) , and as a board member of large powerful health care and health-care related corporations,  I was keenly aware of  the inequities in our health care system. I welcomed the underlying spirit of the Affordable Care Act and read it through carefully, more than once, concluding that the ACA was carefully and skilfully crafted by people who knew what they were doing, understood our system and created needed improvements.  I believed - and publicly stated -  that the ACA improved the long-term potential for  American health care and safety and extended its quality, availability and affordability to all Americans.  I have not changed those opinions.

As I read of the attacks on the Affordable Care Act by partisans of one party, I wonder about Congress peoples', and national political candidates',  undisclosed conflicts of interest which influence their  political activities and public statements concerning the health coverage which our nation, communities, neighbors and families depend upon.  As I watch the run up to the Supreme court  hearing  on the constitutionality of contended provisions of the Affordable Care Act, I wonder about the legal and social objectiveness of the Court's process.

My concern reflects the insightful statement by the biblical king, David, to the prophet, Gad  in which he expresses his distress, concluding  that it is better to fall into the hand of God, for God's mercy is great, rather than fall into the hand of man. With respect to our health care, the decisions will be those of men and women.

In my opinion, all Americans will benefit from the Affordable Care Act. That means my community, family, neighbors and friends. And that includes you, my reader.

AN ISSUE OF JUDGMENT

Since my initial diagnosis of malignant melanoma, I have met a number of new doctors, representing various fields of medicine (specialists in melanoma, oncologic dermatologists, surgeons, radiation oncologists, and others) who work at different types of medical facilities (i.e., medical groups, hospitals), and as solo practitioners.  At the same time, I am well grounded in care provided by highly skilled practitioners, who have been my physicians for years.

I do not accept all of the advice I receive from this population of competent practitioners and I think that I can share with my readers, how I sort through my interaction with reputable physicians and institutions in planning and carrying out treatment of malignant melanoma, a condition which is a major killer of men.  As I interact with physicians (and, to some extent, non-physician health care professionals), to determine basic competence. I ask myself  whether the physician has demonstrated the basic history-taking and physical examination skills that physicians should have.  I ask about physicians' formulation of diagnoses, the additional steps necessary to support the diagnosis, and the treatment plan. I listen for high quality peer-reviewed scientific evidence to support their comments and recommendations.

But during our interactions, I listen for something which is harder to recognize, measure and evaluate, which is evidence that the physician, or other health care provider, has good judgment.  For I learned as a practicing physician, the chair of a large hospital department of medicine,a chief of staff, a member of hospital boards, and an educator of physicians,  no matter what the doctors' skill sets and education may be, without good judgment, that doctor is dangerous.

I recall that one of my partners, a surgeon who practiced at several San Jose area hospitals, once described another surgeon as a person who had an encyclopedic knowledge of surgical literature, but had poor judgment and poor outcomes in his cases.  Through the years, as I represented hospital medical staffs as their attorney in disciplinary cases, and physicians who were the objects of those disciplinary measures, I came to appreciate that partner's observation: I encountered physicians who knew what the books said, but made flawed decisions because of poor judgment.

In a sense, medicine has some similarities to current politics. If the physician - or politician - exhibits behavior, conversation, or conduct which seems to be at significant variance from other physicians or health care providers (or other politicians or the electorate), pay attention. Ask yourself whether you have reason to mistrust the physician's judgment. If so, find another physician or candidate.