http://www.nationalhealthusa.net/overview/

John, we might be on the same side of the line but I fear we are going in opposite directions. I guess you want to be perceived as a person that doesn’t believe in coercion or top down control, but there is an important principle involved. You either accept that principle or you don’t.

Allan… I actually think we are both on the same side of the line. While social media works well, it doesn’t work when you are trying to get sincere and important points across. Those type of conversations really need to happen face to face. Don’t read too much of words like “coercion does not work” vs. “coercion rarely works.” The distinction is subtle but important. I tend to avoid the word “never” because you can always come up with an exception. Coercion is necessary in cases involving things like murder, rape, incest and child abuse because the human behavior is so abhorrent that society has to be coercive. I absolutely do not believe we will solve healthcare’s issues with coercive government behavior. I have spent 20 years engaging clinicians in a very positive way that they find rewarding and fulfilling. When I started, I was young and inexperienced so i was not as good at it. After 20 years, I have learned a lot (not everything, just a lot) as have others. I believe this is the future of healthcare, but we have to engage clinicians in helping address the issues which are very real. If we do not engage, I have no doubt that some group will try to fill the void — nature abhors a vacuum. This is true in society just as much as in science. It would be very unfortunate for patients and society if we cannot all get involved in solutions that i know can work because we are seeing so many examples of it emerging. It is very much in line with physician professional values. It is about us striving to be the best we can be. The vast majority of the many, many physicians i have encountered in my 40 plus year career get up every day with that very goal in mind.

John, you have expressed yourself well maintaining a position on both sides of the line. That is why we continue jousting. This time you say “coercion does not work”, but then you also say “Coercion rarely works well” and other times seem to say coercion is needed when a better solution exists or when doctors are involved in the coercive behavior it’s OK. There is a lot of potential for ‘buts’ and ‘ifs’ inherent in your comments about coercion and that comes out loud and clear.

You have had ample opportunity to clearly state where you stood without the ‘buts’ and ‘ifs’, but you appeared to sidestep the definitive statement and chose to be more ambiguous. Look at how you handled my responses and questions always responding to keep your options open.

Somehow we aren’t connecting. I am probably not expressing myself well. As I said, coercion does not work. It will not solve healthcare’s issues. I believe only frontline clinicians can do that. More government will not help. They currently bring us the Post Office, Amtrak and the VA system. All of them have major problems and all are losing money. Why would we want to have them take over the most complicated industry in the world that represents 25% of the US GDP? Doesn’t make sense to me.

Thank you John, but I was describing what already exists as I wish to limit the entry of more government imposed bureaucracies. Just because some of these bureaucracies being thought of might be run or supported by physicians doesn’t make the coercion taste any sweeter.

Prestor… If you would be at all interested in a complimentary signed copy of my book, I would be happy to provide you one. No obligation, but it will give us more to talk about. Best… John

By golly, I think we finally found something we disagree on that we can discuss over lunch! As I am sure you know, the traditional way issues about the quality of care have been handled on medical staffs is through the credentials committees. Having been on such committees and observed the process, I know for sure that if I were in position of needing someone to assess my care with a patient, I would much rather have a respected committee of my peers assess it than police, lawyers and courts. While there are rare instances that criminal law is justified, I certainly do not want non-clinical police assessing my care, and whenever a lawyer gets involved, it is a long, ugly and expensive process. This is why we have such an expensive malpractice liability problem in the U.S. We need to limit that, not extend it. This has nothing to do with EHRs. Separate issue.

Anyway, love the dialogue. By the way, if you would be at all interested in a complimentary signed copy of my book, I would be happy to provide you one. No obligation, but it will give us more to talk about. Best…