December 2010

Stephen N. Bauer, MD

Rationale for the roundtable

When a screech owl took up residence on our front porch last year, I built a nest box nearby, hoping to make the yard an attractive place for owls and encourage him to stay. A female took up residence a few weeks later, and now their offspring, a young male, is also roosting near the house.

When the first owl appeared, we talked about giving him a name, but elected not to. There was an interesting but unsuccessful proposal for Archimedes, which was Merlin’s owl’s name in the T.H. White story about King Arthur and the Round Table. Merlin was a wizard who mentored Arthur as a boy, often by turning him into various animals. One time, he turned Arthur into a hawk that flew fast over the earth. Merlin asked him what he saw from the sky, and Arthur replied that the boundaries that nation-states were fighting over weren’t real at all, that people were fighting over lines drawn on a map. They were dying for ink on paper.

Camelot, a movie based on the book, came out when I was in high school; it was the sort of movie you had to see with your girlfriend, at least if you wanted to see her again. There was a lot of knight’s combat in the movie, though Arthur espoused that “right, not might, makes right.” Once he was king, Arthur started the Round Table, where each knight was an equal partner and there was a seat at the table for all who respected others, actively sought to do good, and stepped up to defend the vulnerable.

At the CAP Board of Governors meeting that took place just before Thanksgiving, John Scott, CAP vice president for advocacy, was to report on the new CAP policy roundtable. There were commercials on the overhead televisions at the airport about the opening that weekend of the new Harry Potter movie, in which, I understand, owls are featured prominently. So all of this was running through my mind, as I headed out to the meeting.

Our Washington office and the Council on Government and Professional Affairs have always been active in the Washington policy arena, but it has often been in a reactive mode. The policy roundtable will develop proactive public policy focused on implementation of health care reform. We envision it as a forward-looking service to health care policymakers that shows what we do and how we can contribute in our evolving health system. The policies we develop will be data driven and thus underscore our credibility. They will keep patient safety and well-being front and center. Over time, CAP public policy papers will establish the College as a go-to source of solid research and sound policy direction—and establish pathologists as accessible, fact-based thinkers who have their priorities straight.

Health care reform has expanded the role of the federal government in the health care delivery system. Over the next five years, there will be a need for evidence-based, data-driven, sophisticated public policy. We must ensure pathology is communicating and contributing to that work in every way it can. This will be the CAP version of Arthur’s “right makes right.”

The policy roundtable will anticipate change and provide direction for our advocacy efforts, identifying policy gaps to be addressed. We hope to establish working groups for that purpose, to be made up of pathologists and colleagues from the greater medical community along with representatives of academia, industry, government, hospital, and patient advocacy groups. Each team will be asked to focus on specific public policy gaps; to research, study, and debate their topics; then write timely, relevant, evidence-based, and solution-focused documents. At the endpoint, their work products will be made available to anyone upon request.

The policy roundtable is about asserting collective ownership of the problems pathologists face and collective responsibility for their resolution. In pursuing those solutions, we will commission outside research as needed and work with the facts as we find them. We will use the roundtable to build ties not only to our traditional partners but also to professionals in think tanks, institutes, and government offices who are working to build the emerging health care system. The roundtable represents our commitment to take the initiative, to examine the landscape, and to come up with solutions to problems, even those on the horizon and not yet fully formed.

We may not be the biggest medical group operating in the advocacy arena, but we speak with authority. Laboratory testing affects most clinical decisions, and we are central to getting it right. As we develop a library of policy positions that represent the consensus of the laboratory community, government, industry, and academia, the College will emerge as an accessible, trusted, credible, informed, and collaborative organization that has the clinical expertise to determine the right choices for the right patient at the right time in the care continuum.

Looking back on the past few years, as we tried to envision what would come of the proposals for health care reform, there were times when some of us drew imaginary lines in the sand. It will be years before health care reform shakes out, but we have some sense, now, of the changes that are likely to occur. The future will not be exactly as we wish, but it will not be as bad as some feared. We must negotiate what is to come without compromising the quality of care our patients receive.

Those lines in the sand were no more real than the nation-states’ boundaries that disappeared when Arthur flew as a hawk and saw them from the sky. We need to remember that everyone whose work affects health care is on the same team. Each group has its own point of view, but we achieve more by working together. We may not always agree, but if our collective purpose is to do right by one another and our patients, we can strive to take a bird’s-eye view and sometimes agree to disagree. The College is taking the lead here; there is a seat at the table for all whose intentions are good. That is surely as the crow (or the owl, or the hawk) flies.