The post below is by Mike McGuire, MD, FACC, governor of the ACC New Mexico Chapter.

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Things are changing in the practice of medicine, in case you hadn't noticed, and there is the distinct feeling in the air that we are seeing nothing but the faintest hints of the things that will be. 

As I thought recently about the sense of foreboding I was harboring inside about this, it occurred to me I was making a mistake I have made much too often in my life when events seemed (and sometimes were) out of my control.  While contemplating my navel and mentally transmogrifying the events (whether health care reform or any other sticky wicket ) into the collapse of modern civilization and the equivalent of nuclear winter, I was missing one opportunity after another to change my environment for the better and was making the people around me generally miserable. 

A very good friend of mine made a statement that seems to apply nicely to how physicians respond to stressful situations, like the current health care environment.  He said we are trained from our first year in medical school, and usually even before, to deal with difficult obstacles by bowing our necks and working harder, feeling this will either allow us to blast through the problem in front of us or, at least, find solace in stress relief until the issue resolves itself.  It seems to me that, for those of us in cardiology at least, there are better and more productive ways to deal with the concerns before us.

Arguing over facts already plainly understood is a distraction and an impediment to efficient problem solving.  Another good friend, Story Musgrave, a thirty year veteran of the NASA astronaut corps, begins his explanations of how he dealt with difficult problems in space by saying, "It is what it is."  While seeming trite, this mantra relieves the problem solver of the emotions surrounding both what used to be as well as wishful hoping for the future.  What is plain is that the confusion and not a little irritation that many of us feel about current events in the remodeling of health care delivery is actually due to senses of entitlement (i.e., the past: a generally reasonable expectation of the respect of our patients and their gratitude and payment for our long hours of preparation, toil and emotion) and of continuity (i.e., the future: the assumption that we will always be able to set our own courses, whether in incomes, work settings, provision of the newest techniques for our patients, etc.). 

While I believe there is a lot of validity to these views of the past and the future, they are not very helpful right now, due to the shift in control in large measure to people who don't care a fig for how many hours you spent away from your family last week.  It is what it is.  Coming to this understanding and accepting it is the exact opposite of fatalistic acquiescence, because it facilitates the formation of very large goals based upon solid, provable data.  The end result is the restoration to us of much more control over the areas in which we are the experts.  Harry Reid is not among this number.  

The risks we face in simply forging ahead and criticizing the decision makers without providing better options include the loss of trust of our patients.  We will only lose their esteem if we give it away, sell it cheaply or trample it underfoot.  They are not as easily fooled as some people in government and elsewhere have believed, and I think we are beginning to see this in the polls.  Unfortunately, we have not done a proper job of selling ourselves on an individual basis, as we have assumed our good works speak for us.  Society is now factoring in other considerations important to them, not the least of which are the economy and the public's view of its impact on them.  

Predicted shortages of cardiologists in the near future, the aging of America (not to mention the rest of the world ) and the recent leveling off of the last thirty years' decline in cardiac mortality ensure that we will remain in the highest demand, along with GI and Oncology.  Not only are we not going away, we are faced with the remarkable opportunity of figuring out how to care for more of our fellow citizens than we ever imagined.  We can see this as Feast or Unimaginable Burden, but living in the current reality frees us to imagine, help to design systems and set goals not even considered in the past.  While the current hot button is the genuine need for more primary care, it will be a very short time before the laudable initiative of expansion of access to care comes home to roost.  At that point, the systems necessary to provide cardiac care for so many people will be tested, and we have the opportunity now to be pacesetters and designers.

We believe the opportunity to make the health reform process tolerable and even useful is being offered to us.  Covering old ground is counterproductive and we can do better.  

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