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The AMA And Congress: How To Cross The Cultural Divide

The AMA’s communications department kindly sent me a copy of a letter that they (and 9 other professional society CEOs or Presidents) recently sent to Barack Obama and 12 members of congress. I’ve been blogging about the fact that healthcare providers in general, and physicians in particular, do not seem to have much of a voice in healthcare policy. In fact, from what I can tell, Dr. Nancy Nielsen is carrying the torch almost exclusively. I don’t mean to belittle anyone’s efforts, it’s just that I’ve noticed that she is often the only physician at the highest level policy meetings.

So it was with great interest that I read the group letter to Obama et al., wondering what collective message our physician leaders were trying to get across. The writing was academic – using terminology familiar to those heavily steeped in medicine – and emphasized the creation of a patient-centered culture supported by evidence based medicine.

However, the letter raised an interesting question in my mind: Will members of congress read and understand it? I believe that the most effective letters to congress are likely to share three qualities: 1) they must be emotionally provocative 2) they must be written at about the 6th grade reading level 3) they must be brief.

Why Letters Must Appeal To Emotion (“Cultural Competency”)

Dr. Nielsen said at a recent Medicare Policy Summit that speaking with Senators can be “pure theatre.” That has been my observation as well. Decades of experience speaking in large committee meetings have taught them that amusing sound bites or emotional outbursts get attention. In fact, it may be the best way to get things done in congress. For example, did you know that the reason why kidney care is the only disease-based eligibility under Medicare is that Shep Glazer testified before congress during one of his dialysis sessions?

Washington , D.C. , Nov. 4, 1971 – In the most dramatic plea ever made on behalf of kidney patients, Shep Glazer, Vice-President of NAPH, testified before the House Ways and Means Committee while attached to a fully functioning artificial kidney machine.

Minutes before, in the corridor outside the hearing room, Shep told reporters from the AP, UPI, and the Washington Post, “Gentlemen, I am going to tell the Committee that if dialysis can be performed on the floor of Congress, it can be performed anywhere.” As his wife, Charlotte , connected him to the machine, he continued, “Kidney patients don’t have to be confined to hospitals, where expenses are $25,000 a year and more per patient. It’s much cheaper in a satellite unit or at home. I want to show the Committee what dialysis is really like. I want them to remember us.”

My point is that in congress, as opposed to medical meetings, emotion is king. Physicians have a hard time speaking from the gut, since we’re trained to speak from data – because we know that the gut can be misleading. However, my plea to physician groups is this: let’s collect our data, understand the science behind our point of view, and then present our advice in a way that is persuasive to congress. That means we’d probably benefit from a few theatre classes (can we get CME credit for them?) I’m not suggesting that we become undignified in any way – I’m just saying that personal stories, case studies, and appeals to emotion are the currency on the Hill. If we want attention, we’ll need to find a way to make our points in their own language.

For example, I was listening in to a recent Senate hearing on healthcare finance, when a Republican senator began his introductory remarks about “out of control spending” with this:

I must tell you that I have major concerns about our current approach to spending. We’ve already sunk billions of dollars into all kinds of bailouts and programs without any clear benefits. But every time I bring up the excessive spending issue, you’d think I was a skunk at a picnic…

An amusing analogy, and one that resonated with his peers. This Senator understood the culture to which he was speaking. In other words, he had a “culturally competent” message.

Why Letters Should Be Written At About The 6th Grade Reading Level (Health Literacy)

Dr. Richard Carmona told me that one of the first things he learned as Surgeon General was that the American people understand health information at a 6th grade reading level. Thus, there is no point in making a 100+ page medical report on the health hazards of smoking the corner stone of a public smoking cessation campaign.

Health information must be written in a clear, and actionable manner – but it must also be delivered in such a way that it resonates with diverse communities. Letters to congress are no different – many of our congressmen and women do not have advanced medical or science degrees. We must be sensitive to that and write to them in a way that makes it easy for them to understand what we’re hoping to accomplish.

Why Letters Must Be Very Brief

Much has been made of the fact that many people who signed the recent 1000+ page stimulus bill hadn’t actually reviewed it. In fact, it is estimated that 306 members of Congress voted for a bill they had not read.

Of the 535 members of the United States House and Senate,  246 House members and 60 members of the august Senate voted for the $787 billion  stimulus bill without having read a single one of the bill’s 1,071 pages or having any idea of where all of this money borrowed from our grandchildren is going to be spent.

So if our members of Congress don’t read the stimulus bill, will they take the time to read long letters from professional societies? I think you know the answer.


The AMA should be applauded for their lobbying efforts on the part of physicians in Washington. However, my personal view is that letters to congress may be more effective if they are written in a concise, jargon-free, compelling way that respects the “culture” of congress. We physicians hear a lot about “health literacy” and “cultural competency” – and must remember to apply those principles to letter-writing campaigns.

Will any letter influence congressional decision-making? It’s hard to measure the “ROI” of group letters to congress – and certainly they’re only one part of a larger strategy. However, it behooves us physicians to find ways to reach across the cultural divide to speak to congress about the issues that trouble us all: the fate of patients. Letters may be helpful, but an increased presence in Washington, along with some heartfelt reasoning, may be our best shot. Perhaps the Broadway actors affected by the economic recession could help us out?

Dr. Val Meets Mort Kondracke Of The Beltway Boys


Dr. Val & Mort Kondracke

I had the recent honor and privilege of having dinner with Mort Kondracke and his gracious wife Marguerite. Mort’s TV show, The Beltway Boys, offers entertaining and insightful political commentary each weekend.

Mort and I share a common medical interest: Parkinson’s Disease. Mort wrote an excellent book about his late wife’s battle with Parkinson’s. It’s called Saving Millie: Love, Politics, and Parkinson’s Disease. My experience working with patients with the disease has led me to become a supporter of the Parkinson’s Action Network (PAN). I look forward to seeing Mort at future PAN events, and I hope that the recent increase in funding to NIH will help to advance research in Parkinson’s Disease so that we may one day find a cure.

Also at the dinner: PAN CEO Amy Comstock Rick, Robin and Brian Strongin, and my husband Steve. Mort shared some personal perspectives on the famous political figures he’s interviewed over the years – and we compared notes on what they’re really like. Of course I won’t reveal the unsavory stories, but what I can say is that we both agreed that Bob Schieffer is one of the nicest people on earth. Go Bob!

Cartoons & Cocktails 2008 At The National Press Club

I flew back from San Francisco just in time to get to the National Press Club’s annual “Cartoons & Cocktails” event. Two of my cartoons were auctioned off for charity – along with donations from many other artists. Lynn Johnston (the syndicated cartoonist behind “For Better Or Worse”) sent in two original cells, though political cartoons made up the bulk of the offerings (including a signed copy of the scandalous New Yorker cover about Senator Obama). It was truly an honor to have my work featured along with such talented peers.

Of course, I asked my husband to join me at the event to take pictures. I have a new iPhone – and its camera seems to have a bit of a learning curve. I was a little disappointed that my head was cut in half for most of the shots, and that my TV interview with an Indian political team was captured from behind my head. The Washington Examiner had its own photographer – so I might show up in the “social sightings” in one piece.

For your amusement, I offer my husband’s chronicles of the evening:

What Do Doctors Think Of McCain Vs. Obama Health Plans?

Photo of Obama and McCain ABC

A company called Epocrates – which produces drug, disease, and diagnostic guides for physicians – recently surveyed about 1100 physicians about their health policy and political views. These are the 6 questions they asked, with the results listed in descending order of popularity. I think you’ll find it quite interesting:


1. Who has a better plan for healthcare reform, Senator McCain or Senator Obama?

Obama: 47%

McCain: 30%

Neither: 23%

2. As a medical professional, are concerns about McCain’s age justified?

Yes: 51%

No: 49%

3. What issue or reform would you most like to see the new president tackle?

Read more »

Quote of the Day: Why It’s Good To Live In Our Time

Photo of a nice smile

Warning: a short, explanatory digression preceeds the quote of the day. 

In truth, I’ve never been a terribly political person – sure I care about “the issues” but I never really followed politics that closely. Never until I moved to DC. Because here in DC, politics follows YOU. You cannot escape it, you cannot outrun it, and you cannot ignore it. It’s discussed at the local eateries, it’s the driving force behind most social events, and politics (and/or government) is one of the major employers in the district. Escaping politics in DC is like avoiding Broadway on the Manhattan street map. At some point, you’re going to cross it.

So I’ve given in and given up. I’m going to hang with the gang here in as non-partisan a way as any Canadian can muster. You’ll notice occasional posts on policy issues and “inside the beltway” news and conversations in healthcare. I hope that some of you will like that, and the rest will stick with me long enough to get to my next post about important health issues like “flip flop foot” or “conversations at the spa.”

But I have to tell you, these political folks often have a terrific sense of humor. Please enjoy this interesting Q&A between the Archivist of the United States, Allen Weinstein, and conservative author Douglas Brinkley:

Weinstein: If you could choose to go back in time and live in any year in the history of the United States, which year would you choose?

Brinkley: I’d choose this year, 2008.

Weinstein: Why?

Brinkley: Dentistry

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