Culture & Society, Doctors, Medical Ethics, Medicine, Op-eds

I’m Sorry for Your Loss

November 12, 2013 No Comments

In Law and Order re-runs after some tragedy has occurred, prior to grilling the victim’s family the police officer quickly states the obligatory phrase, “I’m sorry for your loss.” It is sterile, meaningless, and as heartfelt as the streaming digital “Thank you” at the automated gas pump.

Fortunately, genuine compassion has been given another reprieve. Pennsylvania recently became the 37th state to enact an “apology law.” When there is an unanticipated outcome of medical care, apology laws allow physicians to express sincere feelings without fear that such expressions will be used against them in court.

These statutes range from shielding all “statements, affirmations, gestures or conduct expressing apology, fault, sympathy, commiseration, condolence, compassion or a general sense of benevolence” (Connecticut) to expressions of sympathy or benevolent gestures, i.e., “actions which convey a sense of compassion or commiseration emanating from humane impulses” (California).

Psychologists teach us that an apology is an important way of “showing respect and empathy for the wronged person.” Apologies improve patient-doctor communication and reduce patient anger. A 2010 Annals of Internal Medicine study looked at University of Michigan and Boston’s Brigham and Women’s hospitals. The study found that malpractice claims decreased by almost one half where hospitals admit and apologize for mistakes.

In an age where physicians are increasingly engrossed in compliance paperwork and have their eyes glued to the computer screen with electronic medical records, any tool that injects humanity is more than welcome. The findings in a recent paper in Journal of Hospital Medicine were telling: only 4 percent of interns practiced “etiquette-based” medicine.

Such etiquette includes (1) introducing themselves; (2) explaining their role in patient care; (3) touching their patients with a handshake, reassuring gesture, or physical exam; (4) sitting and talking with patients; and (5) asking open-ended questions to get patients to relax and talk more about themselves.

These interns are busily learning algorithms, evidence-based guidelines, and fulfilling regulatory mandates. But they will soon discover that checklists will never replace thoughtful individualized care.

A Pennsylvania community hospital Emergency Department looked at physician time usage: direct patient contact, data and order entry, discussion with colleagues, and reviewing records and test results. A whopping 43 percent of their time was spent on data entry versus 28 percent on direct patient contact.

The depersonalization of medicine is disconcerting to be sure. But it is one band on the spectrum of disconnectedness. What is more troubling is the accepted disconnection between people and facts.

At least 80 percent of the comments to the newspaper article explaining the apology law were by people tethered to their hatred. The willfully uninformed railed about how letting incompetent doctors off the hook was what we can expect from a Republican governor.

Per usual, they had not read the article. The law does not shield the physician from malpractice lawsuits; it says that compassionate statements cannot be part of the collective evidence that he breached the standard of care.

The fact is that Pennsylvania’s Democratically controlled legislature unanimously passed the law and the Republican governor signed it. I suppose haters can blow off unjustified steam and begrudge physicians the ability to express spontaneous, unrehearsed, uncalculated empathy.

Of course people reinvent the truth. We have learned from our professor-in-chief: “If you like your doctor you can keep your doctor. Period.”

Well, I am sorry for our losses. I’m sorry for our loss of intelligent discussion of issues in the public forum. I’m sorry for our loss of time with patients when time is absorbed by bureaucratic red tape.

I’m sorry for our loss of patients’ full disclosure of private information for fear it will reach the government’s prying eyes. I’m sorry for your loss of choice of physicians and hospitals. I’m sorry for your loss of low-priced catastrophic insurance policies. I’m sorry for your loss of uncapped contributions to health flexible spending accounts.

I’m sorry for your loss of full-time work hours. I’m sorry that the 20 and 30-year olds who can least afford it are expected to finance healthcare. I’m sorry that the government thinks that having an insurance card equals access to care.

I’m sorry that ObamaCare true believers do not realize that there’s always free cheese in the mousetrap. Period.

Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Culture & Society, Doctors, Healthcare Reform, Medical Ethics, Medicine, Op-eds

Physicians Victims of Body Snatcher Invasion

June 24, 2013 No Comments

Invasion of the Body Snatchers: Where Have All the Doctors Gone?

By author/contributor Marilyn M. Singleton, M.D., J.D.,

After a 20-hour encounter beginning at 9:30 p.m. in the emergency room at my health plan’s hospital, I honestly don’t know what it means to be a doctor any more. When my husband who had a history of bilateral pulmonary emboli developed chest pain, I thought it prudent to go to the emergency room.

We were triaged to the hallway, as there were no rooms. There was an empty room a few feet away, but it had dirty dressings on the floor from the last patient.

After seeing our admitting physician in our hallway “room,” I had high hopes. She had a smile and a white coat over her scrubs and had a note pad and pen. She listened to us.

When my husband offered that I was a physician, she asked what kind and asked what my concerns were. (The next day, she sent my husband an email thanking him for being a good patient, my input, and that she appreciated that we were doing our best to stay healthy.)

Then we were left to the nursing staff and two shifts of physicians who seemed to think they were very special, like stars on a television show called “ER.”

In the charting room, people in scrub attire or T-shirts entered data at more than 20 computer screens. This scene reminded me of a telemarketing sales boiler room. And this fit the level of caring of most of the staff.

I told the evening shift nurse that the pulse oximeter was not working. As an anesthesiologist, I am familiar with the machine. She said that it had been broken all day. My husband, an engineer, asked, smiling, “Then why did you put it on my finger?” She said they were supposed to put it on—and left it there.

Another nurse wanted to put my husband in the dirty room since it was “just for a x-ray.” I advised that there were dirty dressings on the floor and the last patient could have had an infection. He acquiesced and let us go to the cast room for the x-ray.

One of our day nurses kept his back to the bed during his questioning, focusing more on the computer than the patient. He wore a red T-shirt that said “emergency room” on it – the kind you get at a trade show.

He spoke in jargon and abbreviations, and my husband constantly had to ask what he meant. Are they in the new text-talk generation where URROFL (you are rolling on the floor, laughing), or are they showing how superior they are?

Are these the people to whom the authors of the Affordable Care Act want us to cede our profession?

My husband was to have a treadmill test at 9:45 a.m. By 6:00 a.m., after 9 hours without an IV or eating or drinking, I asked could he have anything to eat or drink—even water. The doctor said “no” without thinking.

I said it seemed counterintuitive to have a low blood sugar and dehydration while doing an exercise stress test. He handed us the treadmill instructions. I read aloud the instruction stating that the patient is to have a light meal up to three hours before the test.

Instead of owning that he misspoke, he tried to equate a treadmill test to a general anesthetic where patients should have an empty stomach. At the test my husband was offered water.

When discharge time mercifully arrived, my husband asked our discharging physician about co-pays and whether we needed to pay on our way out. He dismissively said he didn’t know—and didn’t need to say that he didn’t care. He gave the impression that he was content to do his shift and go off to Pilates class.

All but three of the 18 “health professionals” with whom we were in contact in the emergency room were unprofessional and resentful of questions. This appears to be the future of “healthcare reform.”

That is why physicians who still believe that medicine is a calling must resist. They must assert leadership, and not simply follow the flock of sheep.

Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Doctors, Health Policy, Medical Ethics, Medicine, Op-eds

UHCDA – Death Panels Are Already At a Hospital Near You

May 7, 2013 1 Comment

By author/contributor Marilyn M. Singleton, M.D., J.D.

When advance health care directives (“living wills”) were popularized, the guiding principle was to allow patients to choose to “die with dignity.” But one man’s dignity is another man’s poison. Surveys suggest that half of those with a serious chronic illness prefer to die at home. The other half prefer treatment in hospitals.

Advance directive legislation has evolved from a means to ensure patient autonomy to a license for health providers to withdraw medical treatment—even against a patient’s wishes.

Statutory advance directives provide that individuals “have the right to give instructions about their own health care,” but they fail to mention that such instructions may not be carried out if individuals have chosen life. (See, for example, California Probate Code section 4701).

The Uniform Health Care Decisions Act (UHCDA), model legislation developed in 1994, has been adopted in whole or in part by several states. It provides that health-care providers—without legal consequences—may decline to comply with an individual’s health-care decision that “requires medically ineffective health care or health care contrary to generally accepted health-care standards applicable to the health-care provider or institution.”

Not surprisingly, the key term, “medically ineffective” is not defined. Any attempts at specificity would force an open debate on the morality of rationing and “playing God.”

Patients must be informed of the rules before the final seconds of the game. Under state laws, circumstances under which wishes can be denied range from a terminal condition or permanent unconsciousness (Alabama) to being permanently unconscious or “an incurable or irreversible condition” that will cause death “within a relatively short time” (Maine).

Unbeknownst to patients, many hospitals have policies that flesh out treatment withdrawal standards. For example, Stanford Hospital’s “Policy for Medically Ineffective (Futile) Treatment” states:

Medically ineffective refers to treatment that would not offer the patient any significant benefit. If an attending physician believes treatment is not medically ineffective and assumes care of the patient, treatment is not medically ineffective.

This tortured clarification anoints the physician as the final arbiter.

The UHCDA provides that a physician or institution that has decided to withdraw care against the patient’s wishes must make “reasonable efforts” to transfer the patient to a provider willing to comply with the patient’s wishes and provide continuing care until a transfer is made or a transfer is found to be impossible.

This leaves much room for defining “reasonable” efforts, and there may be no options available in areas where medical facilities are scarce. Of course, hospital policies caution physicians that decisions should not be governed by age, race, creed, or economic status. However, if a patient cannot afford skilled nursing care or home health aides, ability to pay determines the outcome.

In treatment withdrawal cases, physicians must continue pain relief and “palliative care.” Stanford’s policy defines palliative care as any treatment that concentrates on reducing the severity of symptoms of a disease or condition, rather than providing a cure. Taken literally, this definition would include anti-hypertensives for high blood pressure and insulin for diabetes.

Is treatment withdrawal about compassion and preventing suffering, or pragmatism and saving money? Medicare spends an average of $24,000 for beneficiaries in their last year of life versus an average of $4,000 for all other beneficiaries.

However, a recent federally funded study concluded that decedents’ average “cost of dying” is only modestly higher than yearly costs for individuals with similarly complex medical needs, e.g., dementia, cancer, stroke, or chronic obstructive lung disease.

Over the last 20 years, one-fourth of Medicare dollars has been spent on services for the five percent of beneficiaries in their last year of life, even with the growth of hospice.

Predictions, such as those from the American Heart Association that heart failure treatment costs will soar over the next 20 years, may compel the government to formulate rigid, bright-line rules and policies that promote a culture of rationing and “letting Grandma go to a better place.”

Making peace with death is a complex personal process. Many would choose to forgo treatment rather than spending every dollar on care they perceive to be of low value.

But most Americans are forced to depend on a system that will increasingly push Grandma onto a pathway to death well before her natural lifespan has run its course—at the whim of elite decision-makers in the name of the benefit of the collective.

Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Health Policy, Healthcare Reform, Law, Medical Ethics, Medicare, Medicine

The Medicare Bundlers and Bunglers Are Coming!

February 25, 2013 No Comments

Medicare: The Bundlers Are Coming! The Bunglers Are Coming!

Author/contributor: Marilyn M. Singleton, M.D., J.D.

My long-time self-paying patient opined that the end of fee-for-service payments (payment for what you get) was imminent. I lightheartedly asked her how physicians would be paid. Would they be housed in military barracks and given vouchers for necessaries?

Perhaps she read section 3023 of the “Patient Protection and Affordable Care Act” (PPACA or “ObamaCare”), the National Pilot Program on Payment Bundling, which applies to certain Medicare beneficiaries.

The program’s stated goals are to improve access to care, quality, coordination, and efficiency (i.e., reduce costs) of services. Pilot programs, which started this year, will be conducted for 5 years, or longer if extension results in improved quality and reduced spending.

An earlier “pilot program” on payment by diagnosis (DRG or diagnosis related group), regardless of what the patient did or did not receive, simply became national practice in 1983 without looking at the results. Then there’s the HMO method of payment by the head (capitation), regardless of care or lack thereof. How will payment by the bundle be different?

A bundle or an episode of care includes the three days prior to admission to the hospital, the hospital stay, and 30 days (not 31 days) after discharge from the hospital. It comprises “applicable services”: acute inpatient services, all physicians’ services in and outside the hospital, outpatient and emergency room services, all post-acute care services (e.g., skilled nursing facility, rehab, home health), and other services the Secretary deems appropriate.

The amount of payment will depend partly on “quality” measures developed by the Secretary in consultation with the Agency for Healthcare Research and Quality. The measures include: functional status improvement, reducing rates of avoidable hospital readmissions, rates of discharge to the community, rates of admission to an emergency room after hospitalization, incidence of health care acquired infections, efficiency measures, measures of patient-centeredness of care, and measures of patient perception of care.

What do these things mean? Does “functional status” mean ability to perform ADLs (activities of daily living)? What if patient is so disabled that his ability to do ADLs can’t improve? What if he still needs a lift to get to the toilet, but can now beat his grandson at gin rummy? Does that count as an improvement?

What about the ultimate measure of functional status—being alive rather than dead? Might a hospital’s “efficiency” rating be better if the patient dies, instead of being readmitted or acquiring an infection?

The bundle will be characterized by a code from the soon-to-be-required U.S. ICD-10CM system. This International Classification of Diseases—Clinical Modification system is based on the 1992 World Health Organization ICD-10 codes. It increases the number of diagnostic codes in the current ICD-9 system from 17,000 to 68,000, including different codes for right or left side. Providers will have to be much more specific in their coding.

Even though providers will have to do much more work to code and do other documentation tasks, the bundled payments cannot be more than what would otherwise be paid for the beneficiary’s care. It is not clear who all will have to share the payment—perhaps the hospitalist, perhaps the patient’s own physician, along with all the team members needed to provide whatever the Secretary deems appropriate.

The changes in “payment methodology” may be seen as a power struggle. Rick Mayes wrote in 2007:

For the first time, the federal government gained the upper hand in its financial relationship with the hospital industry.

Medicare’s new prospective payment system with DRGs triggered a shift in the balance of political and economic power between the providers of medical care (hospitals and physicians) and those who paid for it—a power that providers had successfully accumulated for more than half a century.

Some claim that bundling is a way to save Medicare, previous measures including the Sustainable Growth Rate (SGR) fee cuts having failed. In reality, it simply adds to the opportunity for bureaucratic bungling, while moving payment still further away from the value of care to real live patients.

Instead of more complex formulas, we need more transparency so that beneficiaries can make their own informed decisions about their individualized medical care, without interference from bureaucrats and the special interest groups that feed on the current muddled system.

Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Culture & Society, Healthcare Reform, Medical Ethics, Politics

A Black Physician Reflects on the 2013 Inaugural Address

February 4, 2013 No Comments

Author/contributor: Marilyn M. Singleton, M.D., J.D.

Despite the Martin Luther King, Jr., holiday, many of us were too busy seeing patients to hear President Obama’s second inaugural address. It was less painful to read the transcript.

“What binds this nation together is not the color of our skin or the tenets of our faith or the origins of our names,” he stated. Then let’s end the government’s obsession with African-Americans, Hispanic-Americans, and Asian-Americans (but never European-Americans). We are all Americans. I feel some moral authority and passion on this subject as a black American whose family moved here from England in the 1600s. I am a full-blooded American!

I can’t bear to hear one more person say, “I’m so glad we have an African-American President.” How ironic: Martin Luther King, Jr., urged that we judge people by the content of their character, not the color of their skin.

The head of the Congressional Black Caucus admitted that the CBC treats the President with a “deference” not accorded to a white President, and that the CBC is “hesitant” to criticize the current President. “With 14 percent unemployment [versus 6.9 percent for whites], if we had a white president, we’d be marching around the White House.”

This Administration and/or its tools use race as a crutch when facing legitimate criticism, for example Susan Rice’s willful or incompetent misleading of Americans about the Benghazi deaths. Rep. Jim Clyburn said calling Susan Rice “unqualified” to be Secretary of State was a racist “code word.”

Curiously, “unqualified” was not a “code word” when used against Clarence Thomas in his Supreme Court hearings. It was noted that he was particularly unqualified because he had served on the D.C. Circuit for only one year and four months. God forbid we should raise the same question about Elena Kagan or Thurgood Marshall (whom Thomas replaced), who were never judges at all.

And what about the other Rice? Who can forget how a former Secretary of State, Dr. Condoleezza Rice, was maliciously attacked as a “house slave” in the Bush Administration?

We next learned that the “patriots of 1776 did not fight to replace the tyranny of a king with the privileges of a few, or the rule of the mob.” I guess President Obama and Nancy Pelosi are not part of the Spirit of ’76 since the Patient Protection and Affordable Care Act (ACA or “ObamaCare”) was rammed through Congress with a five-vote margin, 34 Democrats and all 178 Republicans voting against it.

Obama only had one open discussion session, breaking his campaign promise to have open negotiations on C-SPAN. Instead, Democrats in the White House and Congress made private, multibillion-dollar deals with hospitals, pharmaceutical companies, other special interests—and each other.

Moreover, said Obama, “Together we discovered that a free market only thrives when there are rules to ensure competition and fair play.” Rules are fine when the President makes them up along the way. ACA waivers come to mind.

“We must make the hard choices to reduce the cost of health care.” Now that we are learning how “reform” will increase costs, it is clear that naming it the Affordable Care Act was a marketing tool. The most bothersome aspect is that we don’t yet know the identity of the “choosers” who will decide whose care to ration or whose bank account to raid. It is very telling that Obama did not proudly extol the virtues of his signature legislation.

“We understand that outworn programs are inadequate to the needs of our time.” Then, Mr. President, encourage Harry Reid to act on congressional legislation that attempts to restructure Medicare and Social Security instead of deriding these efforts as throwing Granny off a cliff.

Sadly, a thread woven throughout the speech was that Obama will liberate us from our autonomous, free, yet nonetheless pathetic, unhappy existence. He asserted several times that only a select few were making it in America, and he was going to do something about that!

We can only hope that Dr. Martin Luther King, Jr., was right: “A lie cannot live.”

Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Culture & Society, Doctors, Medical Ethics, Medicine, Op-eds, Politics

Black American Doctor Brings Patient Fight to Capitol Hill

October 15, 2012 No Comments

Black American Doctor Fights for Patients from the Operating Room to Capitol Hill

Author/contributor: Marilyn M. Singleton, M.D., J.D.

I was born to be a physician. My grandfather was one of two black students in the 1911 graduating class of Starling Ohio Medical College. He dedicated his life to medicine and helping the low-income folks of Lima, Ohio. My father became an Army Air Force flight surgeon at Tuskegee. As a general practitioner in San Diego, he charged patients what they could afford. Many times we were paid in tamales.

Then came Medicaid. It prohibited doctors from being able to use charity like this. We had high hopes when The Great Society was born: the end of poverty, the end of racial strife. These poverty programs were good intentions gone awry.

What social engineer devised a diabolical program forcing a mother in hardship to eject her children’s father from the house in order to get financial assistance? The road to hell began with this kind of “social justice.” Common sense tells me that families in trouble would derive strength from staying together.

The results of the disintegration of the family are fully evident. Unwed motherhood has almost tripled since the 1960s War on Poverty. Seventy-two per cent of Black and fifty-three per cent of Hispanic children are now born to single mothers. Single motherhood quadruples the chance of living in poverty.

Things have gotten worse, not better. Politicians are so arrogant they tell people to “Trust me!” based on faith, not facts. Are we to believe that it works to treat people like helpless victims? The fact is the poverty rate has not changed in 40 years.

Are we to believe that a check from a distant rich Uncle (Sam) can erase core problems such as distrust of authority figures, poor education, promiscuity, drug addiction, and violence? The facts show no.

Are we to believe that the federal government is effective at public education? The facts show that the high school dropout rate has remained the same for 40 years, despite the fact that trillions of federal dollars were poured into education.

We must support alternatives that offer parental options for educational opportunity. A good education leads to self-reliance and social responsibility. This in turn leads to a good job.

Are we to believe that Medicaid “leveled the playing field” for patients? The fact is that fewer and fewer physicians can take Medicaid due to payments below the cost of providing the services. Where is the “social justice” in a health care system where NO one has quality, individualized care?

We have to change Washington’s way of thinking from “if a social program fails, expand it” to “if it fails, dismantle it.” Today’s policies lead to unhealthy dependence on the federal government. We need instead to encourage independence and freedom. Everyone – at all income levels – suffer from these government-controlled programs because we have more fatherless and poorly-educated children.

Safety nets don’t cure poverty. Education and jobs cure poverty. Family and community are the institutions through which we should help each other. Voting for government bureaucracy is not a surrogate for personally giving our time. Community aid is not only direct, more efficient, and more effective, it is personal. Our personal relationships are crucial to maintaining our civil society.

We can’t let politicians use our differences as a wedge to divide. The rhetoric of class warfare fosters resentment and envy. Class warfare does not sow the seeds of success. Our free enterprise system and the free market of ideas have brought more prosperity and a higher standard of living to the greatest number of people, regardless of race or color.

A free market built on integrity should be protected. We cannot let it be destroyed by excessive entanglement of government with business and crony capitalism. We can use existing laws to weed out bad apples. We do not need suffocating regulations and government control for all.

Finally, we must protect one of the most intimate and life-sustaining bonds in our society: the patient-doctor relationship. Patients entrust their secrets to doctors. How comfortable does it make you feel to know that the National Coordinator of Health Information Technology is watching…or using your personal medical records against you?

Touching lives one at a time is why I became a doctor. Fighting for what’s best for patients is what I do as a physician. These days, physicians must also fight in the political realm so that people can take back control of their own lives.

Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton