The politics of health care

What could state legislation mean to physicians as they discuss culturally controversial but clinically important issues with patients?.

A large part of the recent political debate in the U.S. has centered on health care, specifically the Patient Protection and Affordable Care Act. But politics and medicine have overlapped in other ways, too. Legislatures in several states have introduced or passed laws attempting to dictate, at least in part, the way doctors practice. Last year, Texas passed a law requiring that doctors do a sonogram and describe the fetus to a pregnant woman before performing an abortion, and in California, legislation was introduced to mandate that women be given specific details about their breast density after a mammogram. In perhaps the most publicized example, Florida passed a law nicknamed “Docs vs. Glocks” that forbids physicians from asking patients whether they have guns in their homes. Although none of these measures have yet been put into practice—both the Texas and Florida laws have been stayed by federal injunction, and California's governor vetoed the mammogram law—their proliferation raises innumerable questions. In our cover story, Charlotte Huff talks to physicians, politicians and other experts to determine what such legislation could mean to the practice of medicine and the patient-physician relationship.

Meanwhile, our clinical coverage in this issue takes an in-depth look at prescribing antidepressants in primary care. Recent research shows that patients are often reluctant to mention depression symptoms to their physicians and that physicians in their turn may sometimes prescribe antidepressants for the wrong reasons. Paula S. Katz examines how primary care physicians can help bridge this divide and ensure that antidepressants are used appropriately.

We're excited to launch a new column in this issue, Gray Matters, written by Jerome Groopman, MD, FACP, and Pamela Hartzband, MD, FACP. Gray Matters will look at how physicians help patients navigate preferences, informed consent and other factors to choose a particular treatment, a process the authors call the “art” of clinical judgment.

Health care has been an integral part of the national debate for the past several years, and with an important general election on the horizon, it's certain 2012 will be no different. As always, the ACP Internist staff looks forward to covering developments on the political scene and elsewhere to keep you up to date. You can also find us online at our blog and Twitter account. We welcome your comments.


Jennifer Kearney-Strouse