The UW FP Chair references Dr. Lebow...

I'm at the Pacific Northwest Summit for Transforming Primary Care today. This is, as you know, a time of great energy and discussion about the state of medicine in the United States, and the role of primary care in the solution. And, it's a great discussion.

I was pleased to see, early in the day's discussion, a slide presented by Dr. Jim Davis, the chair of the Department of Family Practice at University of Washington which used as a reference the Healthcare Meltdown, by Dr. Jim Lebow!

It was great to see this, since I find so much encouragement from Dr. Lebow and the testimony of his life's work.

"Delayed Care: Rationing American Style"

There are those of us who have worked toward justice in our healthcare system for years; even when I was a physician-owner of a for-profit medical practice, I was resistant to actions which were inherently unjust toward those in need. So, for many of us, the healthcare reform debate has been a long time coming.

And, I'm still caught off guard that this issue has indeed become so commonplace. I was at a coffee shop the other morning for breakfast with my family. It's a vegan-friendly, dare I say "hippie" place in Tacoma. And, as I turned to put some cream and sugar in my coffee, I saw a flyer for MadAsHellDoctors.com. It's refreshing and encouraging that it's become 'top of mind' for so many people.

But, I'm discouraged that the conversation, the debate, has become so filled with anger, mistrust, and misinformation. So, after hearing some of these concerns from those in our local Town Hall Meetings, let me see if I can adress some of these issues. And, I'll use Bob LeBow's "Health Care Meltdown" as a point of reference...nearly five years after Dr. LeBow's book was first published, it has been revised and re-released.

One of the things that keeps getting in the way of constructive conversation is the claim that healthcare reform will lead to ... rationing. Well, let's talk about that.

In chapter 4 of Health Care Meltdown: Confronting the Myths and Fixing our Failing System, Dr. LeBow adresses the issue of rationing. I've heard many say that America has the best health care in the world. And, I'm afraid that patriotism is being confused with the opportunity and obligation to examine ourselves. We can be patriotic, and still be able to point out areas which need improvement in our country. And, clearly, the area of rationing of health care is one of those areas.

Just this week, another one of those self-evident articles reached publication. (I talked about that on my post "Stating the obvious.") This article has the subtitle "Going without (insurance) coverage greatly increases mortality." Really? I guess we have to state that explicitly for those who say that all Americans (and even "illegals") have ready access to health care, through any Emergency Department. But, the article does go on to help quantify the problem of delaying access to care. And makes the claim that as many "as 44,789 working Americans die each year because they lack health insurance." The study was published this week in the American Journal of Public Health, and notes that more people die each year from lack of insurance coverage (and lack or delay of care) than from kidney disease. (Of course, if you have kidney failure, our government will give you insurance to pay for your care, including dialysis, regardless of your income status - why aren't we upset at that "socialist" act? You have a legally-mandated right to public insurance coverage for this single health condition.)

So, this "news" reinforces what Dr. LeBow wrote - rationing takes place in America, and it leads to delay in care. And, delay in care leads to higher cost care, with lesser outcomes - people without insurance wait to go see the doctor until they "have" to, and then often have lost the benefit of early treatment, when the cost is lower and the chance for cure is much higher. As a physician working with the underserved, I see this every day...

So, let's not kid ourselves. Yes, America is a great place. And, it is not unpatriotic to acknowledge that our citizens are at risk because of the rationing that we currently have; we can do better.

Town Hall meetings...

Gosh, it's been a busy summer...

I've been working long hours, like my partners, in our nonprofit medical and dental practice. We're working harder to see more and more underinsured and uninsured patients.

And, I realize that I need to spend some more time updating this blog with comments about the storm which is raging across the US this summer, as seen in the Town Hall meetings.

I'm struck by the question of one of the attendees of the meeting going on this evening, in Bremerton, where this woman asks why she had to develop renal failure to warrant medical insurance coverage. Great question!

So, I'll see if I can address some of the issues that I hear coming up so often in these "discussions." ...

Summer Seminar in Clinical Ethics...

I'm out of the office this week, at the Summer Seminar in Clinical Ethics at the University of Washington.

I'm sitting in a large classroom, terraced with desktops in front of a projection screen at the University of Washington School of Medicine. It reminds me of so many hours spent in similar rooms during my own med school classes at the University of Kansas. Some things have changed a bit - projector screen instead of just blackboards, and an electrical outlet next to each chair so that I can plug in my notebook computer and connect to the internet via UW WiFi. Actually, I was the first student at the University of Kansas School of Medicine to bring a full-screen laptop computer to take notes in class, back in 1985. That was a Data General ONE. So, computers have been getting me into trouble for years!

So, I find myself in this classroom, with 150 others from around the country, talking with experts about the concepts of medical ethics. And, what a time to review these concepts...

The first case yesterday brought it into focus for me:

"A homeless man with a history of drug abuse visits his primary care physician. Overall, he states he is doing 'pretty good', but is clearly malnourished. He does not have specific medical complaints, but says what he really needs is a loan of $100 to get a 'roof over my head and some food.'"

So, the question posed to the group was, "Does the doctor have a responsibility to the patient?"

And, this brought things into focus for me because we are so embroiled in rhetoric about healthcare reform that we are losing sight of the big issues...

So, does "the doctor" have a responsibility? Well, YES! As a member of society, we ALL have a responsibility to this man. (Have you heard that story about the Good Samaritan? Try reading the story again: Luke 10:25-37.) One of the scholarly pursuits of ethics is to define the underlying principles which lead to ethical decisions, to "right" choices. And, I find the basis for addressing much of today's debate in the red-letter words of the New Testament.

So, that's why I'm here. That's why I'm working where I do. I hope that those around me can see that basis in the way in which I choose to live.

How did the class respond to the question? I'm afraid they answered in a much narrower way, by saying that the doctor had only a limited responsibility to assist his neighbor. We have our text book for the week, but I'm afraid that many of the class didn't bring the other Book!

May 30 March...

We had a chance to join the May 30 March - "Health Care for All in 2009: Mothers Leading the Way."

It was a wonderful experience... I've been really struggling with the environment of our work. Ongoing demand, stories from patients about their financial stressors, and a sense of doom about the economic outlook for support of the Safety Net in our state. But, in the midst of this, I was amazed by the 6000 people, from many different backgrounds, who joined together to make the statement that we cannot wait any longer to fix the HealthCare Meltdown. It was a great "shot in the arm" for me.

I put a few shots from the day up at my Flickr site. And, I've put some links there for some of the news stories about the March. That includes a nice editorial from Carolyn Hamilton Proctor, a woman with whom it seems I might just get along, where she asks, "Am I alone in my confusion on this issue of quality, affordable healthcare for everyone in America?"

We hit the front page!

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Originally uploaded by Doug Felts

Edie Lau and Steve Zugschwerdt visited our new campus in Poulsbo, and prepared a front-page story on the work we are doing serving our community.

This is a shot of Steve, as Chris Adrig PAC works with a patient. She, in fact, has since moved out of the area, but returns for her medical care.

A reminder of Good News...

I just had to share a note about some good news...

It's been a tough day, week, month, quarter... As all of us experience the effects of The Great Recession, my practice has been feeling increasing pressure. We're seeing more uninsured patients, without any increased funding to do so, and we are watching our state cut $1,000,000,000 ( yeah, one billion dollars) in healthcare resources from the next biennium budget. That means many more currently insured people will become uninsured. You can read more about some of the implications here.

Needless to say, it's been a difficult time. We've had two rounds of layoffs, in a practice which has always been rather "bare bones" in our staffing, and leadership staff has all taken a pay cut. Don't worry - no corporate jets and huge executive bonuses here!

But, in the middle of this, I'm reminded this morning of what makes us different, and why I feel a calling to be here.

I saw a patient several weeks ago, a young woman, not unlike one of my daughters. She appeared well. She was dressed in clean and fashionable clothing. She has a strong supportive family, in the middle class. But, she was struggling with an addiction problem. We talked about some options for treatment, which are few, and I planned to see her back in the office in follow up. She didn't come back. But, she hasn't been far from my mind these weeks. I've called a couple of times, just trying to check in with her. No response. And, then today, I felt compelled to call her back. I left another voicemail.... and then, I got her call back! She's been doing well. She's in a treatment program.

I felt so relieved to hear that she's well. It's Good News! And, a reminder that my partners are doing good work each day, for all kinds of people who need our help. People in harm's way. It's a privilege to be able to work for them, to serve them, to see them come to safety and health.

Amen.