May 23, 2025
Dear Interested Readers,
The New England Journal Comes Through
As you may have noticed, I sometimes reference New England Journal of Medicine articles. Honestly, I have been disappointed by the relative silence of the Journal about the political challenges and threats to medical practice, healthcare finance, access to care, public health, and medical research during the first four months of President Trump’s second term. That changed this week when I found three terrific articles in the “Perspectives” section of the Journal, and I am eager to discuss them with you.Â
The first article, “The Power of Physicians in Dangerous Times, ” was written by Alice T. Chen, M.D., and Vivek H. Murthy, M.D., M.B.A. Perhaps of interest to you is that Dr. Chen and Dr. Murthy are married. They have been actively creating and leading organizations that seek to improve healthcare delivery and care experience for patients and healthcare providers. Dr. Murthy served as Surgeon General under Presidents Obama, Trump (briefly), and Biden. The authors begin their piece with a description of the challenges and core questions of this unexpected moment in time:
As physicians, we have sworn an oath to reduce human suffering and protect the dignity and well-being of our community. These values are at the heart of medicine. What do we do when this moral code is under threat?
In recent months, unprecedented policy changes and massive, blunt cuts to U.S. federal funding and the federal workforce have created grave new dangers to health. These seismic shifts have compromised our nation’s outbreak response apparatus, veterans’ care, and medical research from basic science studies to clinical trials. These changes have undercut food and drug safety, disaster response, climate change action, and chronic disease management and have decimated America’s global work to save lives from malaria, tuberculosis, HIV, and countless other threats. Congress has passed a joint budget resolution directing the House committee in charge of federal health spending to cut $880 billion, an amount so great that it will effectively require major reductions in Medicaid coverage and in access to care for economically disadvantaged patients. Work to address disparities in health — to ensure that health and well-being are within reach for everyone — is now being disparaged as political, leading health institutions to censor their language and shutter programs out of fear. There is no doubt that changes are needed to strengthen the nation’s health apparatus. But such changes must be evidence-based and carefully considered, and most importantly, they should improve health.
That is about as succinct a description of this moment and its challenges to American medicine and the health of every person in this country as can be written in less than 250 words. After catching my breath, I read on with the hope that they could do more than just tell us what is happening and what to fear. I hoped that they could give us some words of wisdom about how to react to the challenges of the moment.
This moment is hard enough, but it feels even more difficult because it immediately follows the worldwide pain of COVID experienced by healthcare professionals and everyone on the planet. We are experiencing the “for-profit” corporate takeover of many of our hospitals and medical practices, which distresses many clinicians because they feel that more than ever, corporate bottom lines are given more concern than the needs of patients. As referenced in one of my recent letters, finance-driven decisions are leading to the closure of critical clinical programs in small rural hospitals. The authors state that both patients and providers feel “devalued and dehumanized.”Â
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The authors, like you, know that in the best of times, it is not easy to provide care without experiencing symptoms of burnout and even moral injury. Our improvements in care delivery have often come from the efforts of caring clinicians who invested extra hours of effort after doing more than a full day’s work. The authors continue by acknowledging these difficulties, but reminding us that withdrawing from the moment will not make things better. [As I often do, I have bolded some words for emphasis.]
Standing up to defend the health of patients and our community is not easy under normal circumstances, much less when physicians are feeling short on hope. The onslaught of disturbing news may make us want to tune out and focus on ourselves. But one of the greatest dangers in times like this lies in silence. Silence in the face of harm has consequences that can be measured in lives damaged and lost.
The history of our profession tells us that advocating for those in harm’s way can have a meaningful effect on people’s lives — and can help ease our own despair as well….
After pointing out moments in recent history where physicians made a difference in social changes like the civil rights movement, attempts to control nuclear weapons, and the acceptance of the ACA in forty states, they continue by asking the critical question of the moment and then realistically answer their own questions.Â
Just as our predecessors rose to meet those moments, now is the time for today’s physicians to act. This crisis is bigger than politics. It’s about the health and lives of our patients and communities. So what should we do?
We start, as always, with the patients in front of us. As social services are curtailed and as patients face new barriers to care, we will need to draw on our resourcefulness to help our patients get what they need. Some days we will fall short. On those days, it will help to remember that our compassion and care can be vital sources of strength and hope for our patients who may be anxious and scared.
Perhaps trying to support our patients during the strange moment when our government is busy withdrawing its support from patient care, medical science, and public health will be all some healthcare professionals will be able to do, but the authors are asking us for more:
Beyond our direct care for patients, our engagement with legislators is more important than ever. As worrisome as recent developments may be, many Congressional offices have told us that they don’t have a clear understanding of where their constituents stand on the many policy changes affecting health. That is why physicians’ vocal and sustained advocacy in public statements and in calls and visits with elected officials are imperative. Despite an erosion of trust in institutions, physicians remain one of the more trusted professions, with a unique perspective on health policy. Even when our elected representatives seem rooted in their positions, the patient stories and health data we share can shape how strongly they fight for or against policies — and even slight shifts in a narrowly divided Congress can make all the difference.
One huge disappointment for me over the first four months of Trump’s second term has been the performance of the physicians who have been elected to Congress. Currently, there are four physician senators and seventeen physician members of the House. All four senators are Republicans, as are eleven of the seventeen House members. The most interesting physician senator to me is Bill Cassidy, who is a gastroenterologist and chairman of a Senate committee (HELP)that is critical to healthcare and is a member of the Senate Finance Committee, the Veterans Affairs Committee and the Senate Energy and Natural Resources CommitteÂ
Senator Cassidy was a Democrat early in his professional career. He founded clinics to provide care to the underserved in his community, and his actions demonstrated that he had a deep awareness of the social determinants of health. He was one of seven Republicans to vote to impeach President Trump for inciting the January 6, 2021 riots at the Capitol. He is up for reelection in 2028, which may explain his recent lack of courage. As chairman of the Senate’s Health, Education, Labor, & Pensions (HELP) Committee, he had an opportunity to block the nomination of Robert Kennedy, Jr. as Secretary of Health and Human Services. Like Senators Susan Collins and Joni Ernst, he acted like he would protect us from a horrible nomination, but then he folded to the threat of being “primaried.” There are many examples of physicians who are active in politics. Healthcare professionals are respected as leaders with informed opinions. Drs. Chen and Murthy hope that we can use that respect to make a difference at the levels of local and state government. They write:
Our advocacy should extend to state and local governments as well, which can help protect residents who are at risk of being hurt by federal measures. These levels of government can also advance broader health care reforms, as New Jersey did earlier this year with prior-authorization legislation and as Boston recently did by investing in community health workers. Furthermore, we can encourage and support our colleagues who seek to enter public service themselves, recognizing that physician voices are needed in elected and appointed office at every level.
Even if we don’t run for public office, we have opportunities to make a difference because our individual and collective opinions are respected.Â
In addition to engaging with government, we can speak directly with our communities about the effects of new policies and the changes needed to improve health. These conversations can take place in one-on-one visits, small group gatherings, town halls at our local school or house of worship, and media interviews. Hearing directly from doctors can help people cut through the dense fog of misinformation and understand what is really at stake. We can also advocate in our own institutions to extend extra help to patients at high risk for harm. We can ask community-based organizations how we can support them, whether that means setting up free health screenings or a food drive. Undertaking and celebrating tangible, positive actions — whether they help one person or many — can remind us of our agency and rekindle our hope…
…it is critical to visibly stand up for patients and to support individual physicians in doing the same…The time to stand up for science, patient care, and human dignity is when those values are under threat. Failing to take a stand amounts to a failure of leadership that will damage health and further weaken public trust in the scientific and medical community.
One professional characteristic that many of us share is keeping our thoughts to ourselves. We respect privacy and often prefer to just keep our heads down and do the job alone. I was always amused by the description of the tendency to keep our thoughts private that is embedded in one facetious description of “group practice” as “doctors who share a parking lot.” Our authors advocate for community.
To meet this moment, there is one more thing we need: each other. In moments of hardship and despair, community is everything. It diminishes our pain and sustains our action. This is a time for us to reach out and support each other — to check on each other, listen to each other, and help each other in small ways, whether at home or at work. We can remind each other that we are not alone. There will be times when we need to step back to gather ourselves. That is OK. We can support others who are taking action on the front lines, just as they will support us when we step forward.
The authors continue with an allusion to the famous quote from former Vice President and progressive senator, Hubert Humphrey. The quote comes from his last speech.
“The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the handicapped.”Â
The quote is carved in stone on a wall in the lobby of the building in Washington that houses our Department of Health and Human Services, including the offices of Robert Kennedy and Mehmet Oz. I saw the quote, and was deeply moved by it on my first visit to Don Berwick in his office at HHS after he was named the Administrator of CMS by President Obama. The presdient’s policies and executive orders violate every part of Humphrey’s definition. Our authors are in sync with the spirit of Humphrey’s sentiments:
In the end, the moral test of society is how well it cares for all its people, especially the ill, the forgotten, and those who have been left behind. But societies don’t pass this test by default. They require people who are willing to speak up boldly and unapologetically for the dignity and well-being of others. Physicians have the power to be these people. When we summon the strength to act, our courage becomes contagious. Our actions encourage others to find their voice, and together we build collective power to protect the health of our patients and our nation.
President Trump, his sycophants, and others who lose courage, like Senators Cassidy, Collins, and Ernst, when they contemplate saying no to a powerful president, fail the test when they fold to the destructive policies of the president. I have deep respect for politicians like former Republican Representatives Liz Cheney and Adam Kinzinger, who put principles above party and their political futures. I hope that this essay by Drs. Chen and Murthy will give some guidance and encouragement to all of us who worry about the future health of all Americans.
As a bonus, there is a link to an eleven-minute interview with Dr. Chen. In the interview, she reiterates all of the points made in the article. I hope that you will click here and listen to the warmth of her voice and the positive approach that she expresses in this moment when there is much to fear for patients, medical professionals, our institutions, and the future of our democracy. I was moved close to tears when she referred to the importance of loving our patients and our colleagues as a way of coping in these stressful times. The interview contains all the logic and recommendations of the article.
I will briefly mention the other two articles of interest to me in the May 15/22 Journal. The second article was written by Alexander E. Jacobs, M.D, and is entitled “Sixty Years of Community Health Centers — An Anniversary at a Crossroads.” It has been sixty years since the first two Federally Qualified Health Centers opened at Columbia Point in an impoverished Boston neighborhood and at Mound Bayou in Mississippi. FQHCs and other Community Health Centers remain a critical source of care for over 30 million marginalized Americans, and one must believe that they will suffer greatly if Trump’s “Big Beautiful Bill” passes. A sword of uncertainty will hang over them as long as Trump is in office. The article is both informative and inspiring.
For over a decade, I have served on “the CEO’s Advisory Council” of the Whittier Street Health Center in the Roxbury neighborhood of Boston. Only patients of the practice can serve on the board of an FQHC. I know the many challenges that Community Health Centers face in the best of times, and fear for the harder times ahead that are sure to come.
One of my sons provides mental health services at a Community Health Center in New Mexico, and I worry about the future stability of his practice. I have always been concerned that many healthcare professionals don’t realize how critical these practices are to millions of people. They serve anyone who needs care, whether they have health coverage or not. They are a source of care for many undocumented residents. These compassionate practices deserve more resources, not the challenge of falling Medicaid revenue.Â
The final article is just a feel-good story about how healthcare professionals can gain personal satisfaction and insight from forming closer relationships with patients for whom the social determinants of health can be a fatal disease. The article is entitled “Driving Jackson.” It is told by Rajeev Raghavan, M.D., a nephrologist in Houston. The last paragraph underlines the old principle that “it is more blessed to give than to receive.” Providing care is often a very sacred bidirectional activity. Dr. Raghaven finishes his story by writing:
One week after my visit, Jackson was discharged to a nursing home. I never saw him again. But whenever I drive past his neighborhood, I think of him and remember what he taught me: taking patient care to the next level — whether calling patients on their birthdays or visiting them in the hospital — not only improves outcomes for our patients, but adds meaning to our own lives.
These three articles underline the reality that more than ever, we are challenged to preserve and defend the meaningful and important advancements we have made toward the Triple Aim and equity in healthcare. Complaining has some value, but operationalizing the suggestions of Drs. Chen and Murthy, while being motivated by stories like the ones told by Drs. Jacobs and Raghaven could provide some hope when the outlook seems dismal.
The Season of Graduations and Rain
One of my challenges each week is to find an interesting picture to use as the header for these notes. The weather for the last week here has been a reversion to late winter or early spring. The clouds hang low, and there has been a plethora of rain. There have not been many good “photo ops.”
What good weather we have had this spring has occurred between Mondays and Thursdays. We have had a sequence of seven or eight weekend washouts. Last weekend, we drove to Maine for a 40th birthday celebration for our youngest son. The plan had been for a yard party. The clouds hung low on Saturday, and there was a chilly breeze when it wasn’t raining. The rain was intermittent, allowing the celebrants to be outdoors sitting around a fire pit for short periods. Almost everyone was accompanied by one or more small children. The kids were in and out of the house with little regard for whether it was raining or not. The boys were ages six to nine, plus my toddler grandson. The older boys were busy waving light sabers and pretending that they had guns.
The girls, ages about five to seven, ran around a lot as well, but they also had quieter moments when they were creative. During one of their creative moments, they gathered flowers from the yard and arranged them as a floral birthday gift for my son. It made such a pretty picture, I decided to use that image for today’s header. We can learn much from children who naturally know what many of us have forgotten. Beauty can be created at any moment and under difficult circumstances. We usually have a better choice if we can find the will to look for it.
We are returning to Maine this weekend for my granddaughter’s graduation from Bowdoin College. As might be expected, the weatherman is predicting another weekend washout. We will make the best of it as the ceremonies will probably move indoors with limited seating. There will be parties and a lobster bake. It is Maine. I am sure that it will be a great time even if the weather does turn out to be wet and dreary.
I hope that you have plans for a great Memorial Day weekend, no matter what blows through wherever you are. I am confident that by July 4th, we will have some kind of summer!
Be well,
Gene
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