Representing hospital medicine on Capitol Hill is an opportunity for physicians to educate policy makers and have a hand in the legislative process. Hospitalists who have had such experiences say that it can also be nerve wracking, eye opening, surprising, and very satisfying.
Rifkin Answers a Call to Arms
William Rifkin, MD, assistant professor of medicine and associate director of the Yale Primary Care Residency Program at the Yale University School of Medicine, New Haven, Conn., started his road to Capitol Hill by answering an SHM call to arms. “SHM was looking for someone in Connecticut to appear before the state Health Committee regarding proposed legislation that sought to regulate communications between hospitalists and primary care physicians,” says Dr. Rifkin, who was also asked to address the issue of whether the use of hospitalists should be mandatory or voluntary.
The call originally came from the Connecticut Medical Society, which—along with SHM—helped prepare Dr. Rifkin for his testimony. These groups’ public policy staffs coached him about his audience, the hearing process, and the key issues. They agreed his approach would be educational and informative in nature. He would explain what “hospital medicine is, the advantages and disadvantages, what is happening now in the field, and the issues being addressed by SHM,” he recalls. “I gave the committee members lots of literature and background information.”
Dr. Rifkin had some challenges to overcome in getting his message across to the legislators. “There is no data showing that lack of communication between hospitalists and community physicians has caused serious problems,” he explains. “I had to explain the difference between factual data and anecdotal information.”
Additionally, he recalls, one legislator seemed skeptical about the hospitalist’s role and kept referring to a health system that mandates the use of hospitalists. “I had to sit back and explain how SHM supports a voluntary model,” he says. “She kept talking about a reported example of a hospital that forced patients to use hospitalists. It was awkward because I suspected that the story was untrue or at least was missing some facts.”
By calmly relating SHM’s position and its reasons for preferring a voluntary model, Dr. Rifkin believes he was able to diffuse some of the tension. After the hearing, he approached the legislator and handed her the literature and statements from SHM. “I offered to stay in touch and suggested we find out about this hospital supposedly mandating hospitalists,” he says “Ultimately, I discovered that this story wasn’t true.”
Making a good impression can help legislators see physicians as colleagues rather than adversaries. “After the hearing, the committee sent the communications bill to the Connecticut Department of Public Health Best Practices Committee. This body was charged with making recommendations on communications best practices,” says Dr. Rifkin, who was asked to talk before this group. In fact, he adds, “They’ve asked me back repeatedly. I’m sort of a regular on the committee now.”
He is honored to have input and to present the hospitalist’s point of view. “Their recommendations likely will be similar to what SHM says regarding inpatient/outpatient communication,” he explains.
In retrospect, Dr. Rifkin believes he made a difference. “I felt as if I brought them some new information and taught legislators some things about hospital medicine they didn’t know before,” he says. “I think I helped them see that it would be counterproductive to dictate the specifics of inpatient/outpatient physician communication.”
When it comes to presenting testimony, Dr. Rifkin suggests, “it is best to acknowledge where legislators are right and use this as an opportunity for education. You don’t want to come across as dogmatic.”