Individual responsibility in health care


By Dr. David M. Coddaire

The topic of health care reform has been prominent in the Vermont news in recent years. The Vermont Medical Society, which is comprised of about 1,200 of the state’s medical doctors, has been working actively to make our health care system work better, more efficiently and at lower cost for our patients.

However, our politicians and policymakers are struggling to attain meaningful reform. Such a goal will require the cooperation of not only policymakers, insurance companies and various health care providers, but the efforts of all individuals.

Health care spending in Vermont compares very favorably with other states in the U.S., as does health insurance coverage rates. But we must do better.

All Vermonters should have health insurance coverage, and we need to control costs. As a family physician and president of the Vermont Medical Society, I have a number of suggestions for patients — consumers of health care — which is essentially all of us.

Find a primary care physician or nurse practitioner that you trust and who is part of a 24/7 coverage network. Make that office your base of operations for health care needs. Accessible primary care is well documented to be less expensive than fragmented medical care.

Emergency room care is wonderful for emergencies, but terribly expensive for routine or convenience care. People have more tests and scans when evaluated in ERs. A call to your primary provider can help you decide whether the ER is the proper place to go.

Do not hesitate to question whether a test, scan or surgical procedure is absolutely necessary for you. Doctors typically try to use the technique of “shared-decision making” with patients in making such recommendations, but sometimes we need a nudge.

Take responsibility for your own prevention efforts. As a society we tolerate too much violence on the highways (speed, distracted and impaired driving) as well as in our families. Regular exercise, attention to our nutrition, and caution with our use of alcohol, drugs and tobacco can save us from illness, as well as preserve our health care dollars.

Understand your insurance coverage (this is a challenge). Ultimately the cost of our health insurance premiums affects our paychecks as well as our taxes. Insurance companies are beginning to educate us about the cost of care. Too many people have huge deductibles, which can interfere with accessing necessary care.

I have written a long prescription that is not necessarily easy to implement, but thank you for considering it. Please regard my suggestions not only personally, but in whatever role you have in society whether you are an employer, consumer, policy maker or advocate.


David Coddaire, M.D., of Morrisville is president of the Vermont Medical Society and a family physician at the Morrisville Family Health Center. He also serves as the executive medical director of Community Health Services of Lamoille Valley and is a clinical associate professor at the University of Vermont College of Medicine.