Establishing Representation

In 1998, after becoming so frustrated with how health care was being adversely affected by government and the lack of good leadership and

From: Aging Medicine: Handbook of Pain Relief in Older Adults: An Evidence-Based Approach Edited by: F. M. Gloth, III © Humana Press Inc., Totowa, NJ

representation in Washington, DC, a young physician in Maryland initiated a campaign for US Senate that targeted a well-entrenched (and well-funded) incumbent (1). The odds of actually winning such an election were insurmountable, but the value of such an experience was immeasurable. It provided tremendous insight into what is involved in running for office, and it provided knowledge on the diversity of voters, issues, and public servants. In addition, it provided valuable contacts and direct interaction with hundreds of political officials and supporters.

At the completion of the campaign, two messages were clearly received. First, representation by the health care profession in government is indeed desperately needed. Health care comprises a substantial portion of governmental budgets at every level. Second, the public seeks greater input from qualified health care professionals, as do elected officials, who recognize the importance of health care and generally acknowledge their lack of education in this area.

As this is written, one of the most popular Senate majority leaders in our country's history is a physician (2). Senator Bill Frist is viewed by the public, by those who work on Capitol Hill, and by his colleagues in Congress as bright, caring, and dedicated. This is not the image most people have of politicians, and health care professionals should recognize and embrace this contrast.

Physicians and some other health care professionals often have backgrounds that give them an advantage in running a campaign for office. At the outset, the image is a positive one of altruistic advocacy. The health care profession almost forces a person to develop excellent organizational skills. Many physicians and other health care professionals have experience in public speaking. This provides a surprising advantage on the campaign circuit. It is astounding how many elected officials are poor public speakers. Simply articulating thoughts in a public forum provides a positive contrast to those who cannot. In many circumstances, the skills associated with leadership and communication are combined with an intimate knowledge of medicine and at least some direct knowledge of health care policy as it affects the day-to-day care of patients in a variety of settings. Health care issues today are often among the top issues of campaigns, and if not, they probably should be.

The world-renowned neurosurgeon, Ben Carson, has always found time to participate in the election process. At a fundraiser at which he was the featured speaker and where one of the candidates in attendance was a physician, he brought to the attention of the audience how important it was to have more physicians serving as representatives in various legislative bodies. He noted that early in our country's history about one-third of elected representatives in Congress could be expected to be physicians. Today, the US Senate has but one physician. Dr. Carson's home state of Maryland has only one physician in the state Senate (at this writing, Dr. Andrew Harris is the minority leader). Despite relatively short tenures, both men have been catapulted to leadership positions because of their insight and compassion. In both circumstances, the public image of these physician politicians is very positive, as is the respect on both sides of the political aisle.

For those interested in promoting pain relief, it is desirable to have a representative who has first-hand experience and inherently understands the issues of pain management. The alternative is to spend time and effort educating a representative and generating the needed support for the cause. This leads to the second message received at campaign completion; this is related to getting the needed representation.

The second message is that simply voting on Election Day is inadequate. The campaigns to increase voter turnout are usually targeted at enclaves that are likely to vote for one party (or, occasionally, one position) or another. It can be argued that the country does not need more voters; it needs more intelligent and discerning voting. The number of people who walk into a voting booth and vote for issues or candidates unknown to them is nothing short of astounding. Most could not name their local representatives. Few have ever met any candidate for whom they will cast a vote. Many will complain about politics and their representatives and even voice strong opinions about needing a change in government. Nonetheless, an incumbent running for reelection will win reelection more than 90% of the time in the United States (3,4).

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