I was looking through Time Magazine recently and came across an article about healthcare reform.  It spoke of the daunting task ahead and went through a list of the people at the table in the process of creating change.  The list included politicians, hospital corporations, pharmaceutical companies, insurance companies, and lobbyists from certain large special-interest groups.  Notably absent from the list was physicians and "normal" patients.  I commented about this in a conversation with Val Jones, MD, and she said: "If you aren't at the table, then you are on the menu." She's right.  Up to now, the interests of the people who matter most - the doctor and patient in the exam room - were largely unheard.  Folks said they knew our needs, but they all had their own agendas and so often got it wrong (either out of ignorance or out of self-interest).  Even the organizations that are supposed to represent my needs, the AMA and the specialty societies to which I belong, are not composed of folks who spend most of their time in the exam room; they are people who have either retired to spend their time in Washington, or are full-time smart people (they know lots about other people's business).  There are very few people at the table who regularly see patients.  There are also very few who represent patients without a particular axe to grind (elderly, people with chronic disease or disabilities).

But healthcare is about what goes on in the exam room.  The entire point of healthcare is health care; it is about the care of the patient.  It isn't about the business, the drugs, the delivery system, or the insurance industry; it's about optimizing how the system makes sick people better and keeps better people from becoming sick.  Everything else is a means, not an end.

But those of us who are in the exam room are soon to be served up on the menu for the sake of political gain and special interest clout.  They may or may not have a good plan, and they may or may not have good intentions.  But they definitely do not have an understanding of what really goes on and won't be affected much by the decisions they make.  They are serving up a dinner of food they don't know about and they won't have to eat what they cook.  How can they make good decisions?

A step in the right direction would be to listen to bloggers.  As opposed to the lobbyists and pundits inundating Washington, we actually do healthcare.  The doctor and patient blogs on the web represent the interests of the people who are in the middle of the healthcare universe.  This universe doesn't have Washington DC at its center, it has the patient and those who care for him or her.

A good parallel is the crisis in Iran.  There are reporters and politicians who say they know what it's all about - and in some ways they do - but the voice of the people living in Iran is crucial to understanding what is going on.  Why are there riots?  Ask a rioter.  Was there rigging of the election?  Ask someone who was there to witness the process.  The people who are on the ground should always be listened to.  They don't give the entire perspective, but getting a true perspective is impossible without talking to them.

Don't just listen to me; I represent a specific point of view, and don't represent that of patients or specialists fully.  Don't just listen to patient blogs, as they often don't have a clear understanding of the business of medicine or the complex medical realities (although I know some of them do know an awful lot).  We need to force ourselves to the table.  We need to give perspective that has previously been invisible.

Blogging matters because it gives perspective that could never come from anywhere else.  Blogging is the journalistic equivalent of democracy, giving the average person a chance to make their voice heard.

In July, a group of us medical bloggers will be going to Washington to do what we can to make our voice heard (thanks to Val Jones' hard work).  Maybe it won't make a difference; but at least we won't be invisible any more.