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Us and Them

And after all we’re only ordinary men

The wanna-be congressman appeared with his neat hair and pressed suit, a competent yet compassionate expression on his face. ”The first thing I am going to do when I get to congress is to work to repeal Obamacare,” he said, expression growing subtly angry. ”I will do everything I can to give you back the care you need from those who think big government is the solution to every problem.”

My wife grabbed my arm, restraining me from throwing the nearest object at the television. I cursed under my breath.

No, it’s not my liberal ideology that made me react this way; I’ve had a similar reaction to ads by democrats who demonize republicans as uncaring religious zealots who want corporations to run society. I am a “flaming moderate,” which means that I get to sneer at the lunacy on both sides of the political aisle. I grew up surrounded by conservative ideas, and probably still lean a bit more that direction than to the left, but my direction has been away from there to a comfortable place in the middle.

It’s not the ideology that bugs me, it’s the use of the “us and them” approach to problem solving. If only we could get rid of the bad people, we could make everything work. If only those people weren’t oppressing us. If only those people weren’t so lazy. It’s the radical religious people who are the problem. It’s the liberal atheists. It’s the corporations. It’s the government. All of this makes the problem into something that isn’t the fault of the person making the accusation, conveniently taking the heat off of them for coming up with solutions to the problems.

Taken to its logical end, the “us and them” mentality leads to concentration camps, the Spanish inquisition, the gulag, or McCarthyism. The problems this state of mind creates are much bigger than the ones it is trying to avoid in the first place. Hate crimes are committed against people who aren’t like us, while others are demonized for voicing an opinion that go against the “right” way of thinking. Both of these reactions are extreme, and both of them push us further from the solutions to any problem.

Us and them-ism is also a prominent feature in medicine. Drug companies are evil, Medicaid patients are scum, doctors are too busy counting their money to care, and patients don’t listen to what their caring doctors say. My conservative patients come in to the office assuming that all of the problems in health care are obviously caused by Obama, just as the liberals blamed it all on Bush four years ago. They worry about me leaving medicine because of the passage of the ACA, not really knowing what kind of impact it actually has on primary care physicians. Ironically, the one thing both conservatives and liberals agree on is term limits for congress members, as we all see that the “bad” special interest groups are controlling congress. Maybe that’s more of the us and them-ism, but I can get anyone to laugh at a joke with a congressman at the butt.

“When you don’t have blood going to your head,” I explain, “you pass out so the blood can get to your brain easier. Getting blood to your brain (and your heart) is pretty much essential…unless you are a member of congress, where having a brain or a heart seems to be a liability.” I’ve gotten laughs from the right and the left on that one.

We unfortunately are soon to experience the pinnacle of us and them-ism: a presidential election. Those who govern us leave governance and embrace pure politics. If Obamacare was the best possible law, the republicans would demonize it anyway to avoid giving the president the political upper hand. The same would happen if there was a republican president; this is bipartisan power lust with no apology.

Yet the problem in my exam rooms remains: care is too expensive, there is more red-tape and less good care, more patients have no insurance than ever before, and doctors are getting really, really tired of dealing with this mess. Patients die due to poor access to care (far more than most people realize), and many grow rich off of a system which pays more attention to shareholders of device manufacturers than to the patients with the devices in their bodies.

The intersection between health care and politics is the place where I lose my temper. Politicians playing the power game with the lives of my patients are my arch nemesis. This is insane. This has to change.

When I was a medical student I did a cardiology rotation. I had a patient who had a heart attack and was sent to the floor, seemingly stable. I met her and her family, getting to know the situation as well as could be understood by a student. I heard the overhead page for the code on the ward she was in, so I ran to see if it was her who had suddenly crashed. My heart sank when I came to her room and saw a flurry of activity around her doorway, with her family somberly standing outside while people hurried in and out of the room. Her husband’s eyes were tearful as I came up to the doorway.

“It’s Maria,” he said to me, “She just stopped breathing.”

I gave a weak smile to try to comfort him. “I’ll go and find out how she’s doing.”

She wasn’t doing well. Her heart rhythm was nothing I had ever seen before and her face was ashen. The respiratory therapist was assisting her breathing using a bag-mask and the nurses were attending to her IV. The cardiology fellows I was working with on the rotation were in a corner, far away from the woman, arguing with each other.

“I think it’s a junctional rhythm with PVC’s,” said one with passion.

“No, it’s clearly a left bundle with a-fib,” argued another, with derision in his voice.

As the argument went on between the doctors, the woman grew more pale. She was obviously dying. I thought about her husband, not able to be with his wife as she lay dying in bed, away from him, instead being the subject of an academic debate about heart rhythms.

I felt sick.

The rhetoric on health care seems eerily similar. The patient is laying on the bed dying while the politicians are vying for the upper hand in the debate. The patients are ignored, though, serving as a tool with which to smear the other side. Just like I felt when I was a medical student, I feel powerless to do anything while a tragedy unfolds before my eyes.

With, without

And who’ll deny that’s what the fightings all about

Get out of the way, it’s a busy day

And I’ve got things on my mind

For want of the price of tea and a slice

The old man died

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at More Musings (of a Distractible Kind) where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player. He is a primary care physician.