August 1997
Volume 61 |
Number 8
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| Practice Options:
On Being a Doctor in the House |
Kyle L. Janek, M.D.
In this and following issues, the ASA NEWSLETTER will
be publishing articles about some of the various practice options
available to anesthesiologists today -- inside the operating room
and in other venues.
In early 1991, I threw my perfectly normal life into turmoil
by my decision to run for the Texas House of Representatives.
While this career detour was not made without a lot of thought
and reflection, to this day I find it difficult to answer the
question most frequently asked: "Why interrupt a medical
practice to go into politics?" The response I generally mumble
is something about having fallen in with the wrong crowd.
Since being elected in 1994 (the voters turned me down in 1992,
probably to give me a little more time to think about the question
above), I have attempted to lead two different careers simultaneously.
As the Texas Legislature meets in formal session for 140 days
every two years, most of my time is spent in a full-time anesthesiology
practice at a large suburban hospital. However, my duties as a
state lawmaker still demand some 15-20 hours each week answering
mail, attending meetings and functions, returning telephone calls
and generally attending to the needs of my constituents.
At the time of this writing, the Texas House is currently in
session, and that means politics is my full-time job. I am most
fortunate to belong to an incredible group of dedicated anesthesiologists.
Their encouragement and support allow me the flexibility to move
between the two careers. I am proud that our large state (were
it a separate country, Texas' economy would rank as the 11th largest
in the world) continues to be governed by a citizen legislature,
but it does mean that we must accomplish a great deal in the 140
days allotted for the regular session.
Hospital committee meetings for me have now been replaced by
the House Committee on Public Health and the House Committee on
Business and Industry. Instead of visiting with patients and their
families, I have a steady stream of constituents, lobbyists and
tourists who come by the capitol office. The operating room has
been abandoned in favor of the floor of the Texas House of Representatives.
That medicine and politics are worlds apart can be illustrated
by three points. The first is that in medicine, right and wrong
can ultimately be defined as that which is best for the patient.
In politics, however, right and wrong are not seen as absolutes.
Rather, they seem to lie somewhere along a spectrum, and one can
be at any point (moving in either direction) and still claim to
hold the high ground. For me, this lack of clear goals in government
is most distressing.
The second difference is one of decision-making. In medicine,
the predominant pathway is still a fairly direct one: as the history
and physical, lab work and consultations come together, the patient
and physician use this information to lay a course of action.
In government, decision-making is much more diffuse. Proposed
legislation in the House must clear committee hurdles (where it
can be changed), floor debate (where it can be changed), Senate
committees and floor debate (where it can be changed) and the
Governor's office (where it can be vetoed). Should a bill become
a law, it frequently must be implemented by a state agency whose
rules and regulations can actually change it further. My point
is that this long process allows many people to affect the final
outcome.
The third, and most striking, difference between politics and
medicine is one of trust. People trust their doctors. Not just
their doctor; as a general rule, people trust doctors as
a group. It always amazes me to meet a laboring patient at 3 a.m.
With an expectant mother in a lot of pain and an anxious father
listening, I introduce myself and explain the procedure, side
effects and possible complications of a labor epidural. Almost
without exception, the parents accept the risks and ask very few
questions. On the other hand, when people meet me as a politician,
their attitude is evidently different. (After shaking hands, many
will check to see that I have not removed their rings or watches.)
As one might imagine, making the change from medicine to politics
and back can bring on a few headaches. But what really keeps me
awake at night is the thought that one day the worlds of medicine
and government might not be different: that right and wrong
in medicine are debatable commodities; that decisions are made
by committee, by people with little or no working knowledge of
the subject matter; that trust is a rare thing.
As the only practicing physician in the Texas Legislature (I
am joined by a retired family practitioner), my colleagues frequently
consult me on health care legislation. As I dispense my advice,
my guiding principles are the best interests of the patient and
the preservation of the doctor-patient relationship. I believe
these principles to be the foundation for the greatest health
care in the world.
Kyle L. Janek, M.D., is Staff Anesthesiologist
at Memorial Hospital Southwest, Houston, Texas, and a member of
the Texas House of Representatives.
E-mail the author.
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