Supreme Court decision can’t help with “goals of care” or “less is more” conversations

With the permission of the editors at theHeart.org, a version of this post also appears on Trials and Fibrillations. I wasn’t going to write on this matter, but I changed my mind.

You know the news: the US Supreme Court upheld the Affordable Care Act.

As a doctor in the mix, it seems appropriate to weigh in — ever so briefly.

First, take a deep cleansing breath.

I am highly conflicted about the Supreme Court’s decision. Part of my brain tells me that I should be stomping around in an inflamed state. But I don’t feel that way. Basically, I don’t feel much. It’s not that I think the case isn’t important. It is. Make no mistake: how we, as a nation, treat the less fortunate among us says a lot about who we are.

But really, did the decision matter? If the ACA was struck down, would a better system have emerged? In this political climate? Would an alternative system effectively solve our three most pressing healthcare problems: covering everyone, controlling costs and maintaining the sanctity of the doctor-patient relationship?

I doubt it. Especially since we can’t ever talk about doctors making mistakes, or that smart medicine does not mean more medicine. Less-is-more talk gets beat down as rationing, while goals-of-care discussions bring up death panels. There’s a lot of work to be done.

That’s why I’ve decided that all I can do is show up each day and work hard to positively affect the world in which I live. For me, as an experienced physician, this means working effectively in the healthcare system chosen by the people, whether I like it or not. I have to trust that the American people will choose wisely.

I’m a doctor. And doctoring allows me to do the most good. For this I am grateful.

As far as writing about healthcare issues, I’ll keep at, in the hope that my experience in the real world contributes constructively to the debate.

Think positive.

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