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Senate health care bill, physicians and shame

Esther Choo, M.D., M.P.H.
Esther Choo, M.D., M.P.H.. (OHSU/Kristyna Wentz-Graff)

Over the summer, I led a project called #DoctorsSpeakOut, in which I asked physicians across the country to record how they felt about the Senate health care bill. Many had stories about individual patients who had benefited from the Affordable Care Act and Medicaid expansion. They marveled about how their patients’ lives seemed to fall into place with health insurance. How cancers could be detected early, chronic conditions stably managed, and the devastating end stages of disease avoided.

In the process of obtaining the videos, I spoke and emailed with hundreds of physicians. Many of those who responded to the call were adult or pediatric primary care providers, who see patients over years as they thrive or decline and are in the front seat, so to speak, of the real-life stories that play out years after policies are enacted. But my peers surprised me, for among them were also subspecialists: surgeons, radiologists, anesthesiologists.

As Republican senators continue to construct bills with devastating consequences for Americans, I have heard the same words over and over again, relaying how deeply individual physicians have been affected by the specter of this bill. "I'm anguished," one physician told me; others used words like "sick to my stomach," or "horrified," or said they could not sleep at night, thinking about what may happen if the bill passes. But the most common word I heard was “shame.”

Shame … why shame?

Throughout our long training and careers, physicians are prepared for so many things.  My friend likes to tell a story of a single shift in which she extracted a bead from a toddler’s nose, resuscitated a woman in cardiac arrest, replaced a dislocated shoulder, and delivered a baby. All fell within her skill set, quite easily. What has been so devastating about this bill is how it renders any of our skills ineffective.

In Washington next week, somewhere around half of our Senators will cast the vote to make deep cuts to the Medicaid program. In our hospitals and clinics, we will see with our own eyes the reverberations of those votes. We will see the people who make the hard decision to keep the heat on instead of seeking a primary care visit, who wait a few days with chest pain before coming into the emergency department -- days that may cost them their lives -- who have to agonize over seeking simple, basic, life-preserving care for themselves, their children, or their elderly parents.

What is shame? It is “a painful feeling of humiliation or distress caused by the consciousness of wrong or foolish behavior.” Physicians feel shame today because we recognize the wrongness and foolishness of these health care bills, and yet as employees of hospitals and clinics and health care systems, we are tied to the machine that will bear out these changes.

And we feel shame precisely because all our carefully cultivated knowledge and skills seem completely beside the point in the fight to prioritize the health of all Americans.

If I could go back in time and tell my younger self in medical school or residency training one thing, it would be to stop worrying about memorizing facts, or how perfectly I place a central line or obtain cerebrospinal fluid. Those skills come with time and practice. But at no point did our training teach us – or even help us begin to appreciate how vital it sometimes is - to advocate for our most vulnerable patients when the very health system is turned against them. This is the root of our shame.

Esther Choo, M.D., M.P.H., is an associate professor of emergency medicine, OHSU School of Medicine, OHSU Center for Policy & Research in Emergency Medicine.

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