Carmen R. Green, M.D. (Residency 1992), associate professor of anesthesiology and director of the Pain Research Division, spent a year-long sabbatical in 2007 working on health care policy in Washington, D.C., as a fellow in the prestigious Robert Wood Johnson Health Policy Program. Green specializes in pain medicine, especially disparities in pain and its treatment relating to race, ethnicity, gender, socioeconomic status and other factors.

Q: What kind of experience did your Robert Wood Johnson fellowship provide?

A: The RWJ Health Policy Fellowship is considered the premier health policy program in the country. It gave me the rare opportunity to work in the U.S. Congress as a public servant, and to learn how health policy is made. My goal was to really understand the people and process at all levels such that I could be involved in that process. I met with people, including some who report directly to the President, who influence and make health policy — the executive branch, including NIH and CDC; the legislative and judicial branches; think tanks and advocacy groups, major thinkers in health policy. I also met with key policy-makers at the state level to understand how state policy influences federal policy and vice versa. But most of my work was in the U.S. Senate, where I worked on several pieces of legislation.

Q: Why is it important for Michigan to have a presence and voice on the national scene?

A: It’s essential that we don’t forget about the power of the people who actually take care of patients, whether as a physician or a nurse. Members of Congress and their staff are rarely physicians, scientists or other health professionals. Many have no health background whatsoever. It’s important for health professionals to be involved in the policy-making process. The role of academic health centers is particularly important since we care for people — especially those who are most vulnerable — and serve their most human needs, including care for pain. The U-M sees a significant number of Medicad patients, while also caring for the uninsured and underinsured. It’s in our best interest to be involved at the national level, because what happens there affects what happens at the local level, and at the patient-physician level.

Q: What is the impact of pain on our nation?

A: People and policy-makers don’t recognize how much pain costs this country. It’s one of the most frequent reasons people see physicians and the most common cause of disability. Pain costs more than cancer and heart disease combined. When you add lost productivity and quality of life in an aging society, it’s a huge cost. People suffer, and there are disparities in care, and pain continues to be viewed as a symptom.

Q: What can be done?

A: More people with health expertise need to understand and inform the process. Very little has been written on pain as a health care policy issue. I hope to do some of that. We still have 47 million Americans without health insurance, and more are underinsured; it costs us all. We’re in a deficit situation and health care is becoming increasingly unaffordable. Medical education costs are skyrocketing. We need to come together — Democrats and Republicans, government and private sector, physicians and patients — to solve these persistent national problems and figure out a solution that works. It’s unconscionable to pass on this type of debt to our children and to have so many Americans uninsured.

Q: Did you find any correlation between your work in the Federal government and your work as a physician?

A: Absolutely: the process of active listening, whether it’s listening to your patients and their stories to provide the best treatment for each individual, or between legislators who disagree. With several of the bills I worked on, we worked together, democrats and republicans. Sure there were disagreements on principle, but there was a whole lot of agreement, and that’s where both sides can come together and begin to build something good. The question becomes how can you start actively listening and, besides listening, actively doing and finding some common ground, because there is much more common ground. Actively listening to patients also creates a sort of common ground, on which physician and patient can work together toward common goals.

I think we have to sort of really listen to the stories and think about what would happen if we removed ourselves — “what’s best for me” — and say, “What’s best for our future, our collective future?” I think we might make decisions a bit differently. Good people with good conscience can do amazing things.