After what seems like an eternal campaign season, it is hard to believe that by the time this blog posts we’ll know who the 45th president of the United States will be. Although the election has resulted in a treasure trove of comedic material generated by late-night talk show hosts, if discussions between Democrats and Republicans in my own family are reflective of broader trends, it’s also been a dispiriting election year. Supporters on both sides are often so angered by issues of the opposing candidate that they have a hard time acknowledging blemishes in their own nominee.
Regardless of who wins, here are 3 broad priorities in the medical field, above and beyond affordable and accessible health care, that I strongly urge the next president to address (after all, if the current President recently wrote an article in JAMA, maybe future presidents will be looking at JAMA Ophthalmology and its blogs, too). In providing these recommendations I humbly acknowledge that I’m not at all a public policy expert. But these issues touch the lives of me, my patients, and my colleagues in the field of retina on a daily basis. I think there is real opportunity in each of these areas to create a healthier, happier America over the next 4 years. So here goes:
1. We need to reach beyond treating advanced complications and emphasize disease prevention. Over the last few decades, this country has seen substantial gains with regard to reductions in retinal disease through nationwide improvements in systemic control of diabetic risk factors and substantially lower rates of smoking. Yet we still see patients on a daily basis who have uncontrolled blood sugar or blood pressure and who may not even know that these factors influence their retinal health. Educational initiatives can have a major impact on disease prevention in a cost-effective manner, but we need a more systematic approach toward health education that is also culturally sensitive across racial, ethnic, and religious differences.
2. We should encourage greater collaboration and cross-talk between medical specialists and primary care physicians. Most of us agree, in theory, that better communication among a patient’s health care team could only improve the quality of care that patient receives. And yet silos remain, with ineffective or often absent communication between a patient’s multiple health care providers.
3. We should improve standardization across electronic medical records. The increasing digitization of our national health care data has created both challenges and opportunities. Currently, merging of data from disparate systems is difficult due to inconsistencies in how these data are recorded and which data are captured. The American Academy of Ophthalmology’s Intelligent Research in Sight (IRIS) registry, along with other nationwide medical registries, has strove to overcome some of these inconsistencies, but much work remains to be done. Greater standardization of the variables and outcomes across electronic health records could enable the development of more readily searchable and complete health databases. These could help us better track quality outcomes nationwide, monitor treatment safety, and efficiently answer key clinical research questions.
There are many other important issues, including the need for evidence-based, effective treatment approaches that are not overly burdensome in terms of cost, fair determination of compensation-determining relative value units among and between specialties, and the need for better incentives for ophthalmologists who may otherwise shy away from pursuing relatively underpaid careers in clinical, basic, or translational research. You may or may not agree with my priorities as listed above. If not, feel free to comment on this piece. I welcome your insights.
Election season aside, I’m motivated to think about these public policy topics partly because I’ve been listening to the Hamilton soundtrack along with my teenage son. In my opinion, the lyrics are brilliant and the performances are tremendous, but I love it most of all because it makes the debates that forged this nation so contemporary and vibrant. The great strength of our American system is that it flourishes through thoughtful and impassioned discussion about complicated policy issues. To be effective, however, health policy discussion also must be respectful and collaborative. Past partisanship has made it unnecessarily difficult to find workable solutions to our healthcare woes. It is my hope that these topics reach beyond political party lines and can be addressed constructively in future dialogue about our health care system.
So whether I’m addressing future President-elect Clinton or Trump, I urge our leaders to consider these recommendations for prevention, collaboration, and standardization in their health care plans over the next four years. And to Lin-Manuel Miranda— if you by some miracle happen to be a regular reader of the JAMA Ophthalmology website—I know I am late to the game in telling you that you are awesome and your musical is a game changer. Nonetheless, thank you for reinvigorating my faith in the American political system. And thank you even more for making it cool for a teenager to hang out with his mom!