EDITORIAL

‘The Only Thing We Have to Fear is Fear Itself’ “The only thing we have to fear is fear itself.” Franklin D. Roosevelt e First inaugural address, March 4, 1933 High anxiety levels are quite common these days among my medical colleagues. Of course, there are some very real issues of concern for all physicians. For example, how is the new “Obamacare” health plan affecting our daily work lives? Will our income decrease substantially? Will there be new waves of “chart police” checking every progress note and order we write? Will we all have to work for a giant unfeeling and distant corporate entity that does not understand the subtleties of our individual practices? Will I be able to continue to follow my own independent style of practice or will I be locked into a series of formula-driven health care algorithms? These are just some of the topics I hear doctors discussing on an almost daily basis. There is no question that palpable fear underlies these conversations. Patients are equally fearful. Will I still be able to see my own doctor who has taken care of me for many years? How difficult will it be for me to navigate in a new giant corporate health care system? Will there be restrictions imposed on what diagnostic and therapeutic approaches can be used in my case? What if I lose my health insurance? How easily can I enroll in a new plan? Will my out-of-pocket health care costs skyrocket? In reality, recent problems in enrolling in the new system have also fueled considerable patient anxiety. In this context, it is important to remember that fear in the face of change is a common human quality. Any disturbance to the comfortable status quo can lead to anxiety. I sense this anxiety in my patients every day when they ask me what I think of “Obamacare”. Those of you who know me will easily predict my response to this question. I tend to be a dyed-in-the-wool optimist, particularly when it comes to anticipating future events. Despite problems, inefficiencies, confusion, and misunderstandings in our daily lives, we usually manage to muddle through

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to a successful conclusion. There are lots of examples supporting my optimistic viewpoint. I find that when we attempt to control human behavior, despite a number of false starts, we usually come to a more or less satisfactory outcome. For example, take our experiment with alcohol prohibition. Although it was a great success for the criminal element in our society, it really did not work very well for the rest of the population! In the end, we arrived at a negotiated settlement that is not perfect but that works for the majority of Americans. As Winston Churchill is alleged to have once said during a visit to the US: “Americans will always do the right thing after they have exhausted all the alternatives.”1 In other words, we arrive at a workable solution to a problem after we have tried and failed with many alternatives. This is the reason I believe that “Obamacare” will succeed in the end and will enable many individuals to receive quality health care for the first time. Of course, there will be many more stumbling blocks encountered before we arrive at a satisfactory solution. In this regard, it is important to remember that the Medicare legislation of 1965 that passed with the help of Lyndon B. Johnson is not the Medicare legislation of 2014. The law has been tweaked, expanded, and clarified multiple times since its inception in 1965. I am convinced that the same thing will happen to “Obamacare.” I just hope that I am alive in 25 years to see if my prediction turns out to be correct! Finally, and most importantly, what will never change are our patient’s illnesses and their need for our care and attention. For me, this is the overriding issue and the main reason that I am optimistic about the future of health care in America. Dedicated physicians, nurses, and other health care workers will ensure that patients get the right diagnostic and therapeutic interventions. Thus, despite the occasional “potholes” in the road to excellent health care for all Americans, I am convinced that we will reach the end of the road successfully and in one piece. The only question is how long it will take us to get there! There are lots of reasons for physicians and patients to be fearful given the present uncertainties with respect to our health care system. Nevertheless, I think fear and anxiety will dissipate both for the doctors and for the patients, as we work out all the various kinks in the new health care law.

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The American Journal of Medicine, Vol 128, No 4, April 2015 Joseph S. Alpert, MD Professor of Medicine University of Arizona College of Medicine Tucson Editor-in-Chief The American Journal of Medicine

Reference 1. Quotations: Winston Churchill (1874-1965). Available at: http:// www.dropbears.com/h/history/winston_churchill_quotes.htm. [However, http://quoteinvestigator.com/tag/winston-churchill attributes this quotation to Abba Eban, an Israeli diplomat]. Accessed July 26, 2014.

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