Posts Tagged ‘medicine’

Practicing What Jesus Preached about Healthcare for the Poor

July 29, 2013

You could say that maybe if we had thousands of philanthropic physicians like Grant Scarborough and those who support him, our country could provide affordable health care for all.  Maybe we wouldn’t need single-payer or Medicare for all to solve the crisis of exploding costs and millions without healthcare insurance.  Of  course, that alone would not solve the problem.

Dr. Scarborough is Founder and Executive Director of Mercy Med.  It’s a religiously inspired non-profit organization that provides healthcare for the poor.  He and his paramedics treat anyone who walks in the door of his clinic in the former CB&T banch building on 2nd Avenue whether they have insurance or not.  Speaking to the Rotary  Club of Columbus, he said, “individuals come in and pay an average of 28 dollars and get over 300 dollars of health  care. It’s a great deal.”  If someone comes in who is  making more than $45,000 a year, he’ll charge them 45 dollars for an office visit.  What if you are homeless and can’t pay? No one gets turned away.

It’s also a great deal for hospitals with emergency rooms, because clinics like his save them millions of dollars.  Many of those who use clinics like his would simply go to the hospital emergency rooms for their treatment if those clinics  did  not exists.

He is motivated by the lesson of the Good Samaritan parable that the Bible says was told by Jesus Christ.  The Good Samaritan stopped to help the man who  had been beaten and robbed.  Took him to an inn and gave the  innkeeper money to care for him, and said he would back and give the innkeeper more if more was needed.  And Dr. Scarborough invites us to  join him in his quest.  He said, “I encourage you to get involved with us or with another ministry, or with another country, and consider, and then be kind to the poor by loving your neighbor.”

I said earlier that having thousands of doctors like Dr. Scarborough might solve our healthcare crisis.  However, physicians ares only part of the picture.  There are other elements involved, things like hospitals, labs,  diagnostic centers, and pharmaceutical and insurance companies.

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The Overburdened, Understaffed Emergency Room – Part 2

April 25, 2011

The Medical Center Emergency and Trauma Center's ambulance entrance

  I asked the nurse assigned to me, “How many doctors are on duty tonight?”  She replied , “Two.”  That confirmed my suspicion that The Medical Center’s Emergency and Trauma Center was understaffed that night, Sunday, April 3, 2011. That suspicion had been formed when another nurse, the one assigned to triage, told me that wait times would probably be up to seven  hours for some of the many people sitting in the ETC waiting room, and the average wait would be about five hours.  Because I had a head wound and was on a blood thinner which could have increased the chances of internal bleeding, I didn’t have to wait that long.  I got to see a doctor in about two hours from the time I signed in. 

So,  my impression was the ETC was like emergency rooms all over the country, overburdened and understaffed, but was it? In my opinion, that  night, Sunday, April 3, 2011, it was.  However, it was not a normal night. I learned just how abnormal it was when I posed a few questions to Marion Scott, who is Director of Communications for the Columbus Regional Medical System.  I decided to let her speak for herself unedited. This is what she wrote to me.

On the night you were treated, staffing in the ETC was at the “best practice” standard as set by the national Emergency Nurses Association. Staffing ratio is one nurse to four patients.
 
There were two emergency physicians in the ETC that evening; again, an appropriate staffing level under routine conditions. Residents from our teaching program do not routinely work in ETC. They do report to the ETC for duty when we call “trauma,” a designation indicating extraordinary and severe patient volume that increases staffing across clinical and non-clinical support areas. We typically have one to three trauma cases in a 24-hour period. In the 24-hour period during which you were treated, we had 20 trauma cases – seven to ten times the normal trauma volume.
 
You also asked about the number of patients treated in the Emergency and Trauma Center who cannot pay for care. For our last full fiscal year, which ended June 30, 2010, 86 percent of the total patient encounters through the ETC were uninsured and 33 percent resulted in uncompensated care. The Medical Center’s total uncompensated care for last fiscal year was just over $32 million.
 
As you and I have discussed, the greater issue related to emergency care is the number of people who use an emergency room for minor illnesses and injuries and for primary care. Approximately 40 percent of the patients treated in The Medical Center’s ETC could have been treated in a more appropriate setting, such as their physician’s office or an urgent care center. The result of inappropriate use of an emergency room is overcrowded emergency rooms with long waits, inefficient use of hospital resources and higher costs for patients and insurers.
 
Also, many people treated in an emergency room for minor illnesses and injuries do not have a physician, or “medical home.” It is so important to have a physician with whom you can establish an ongoing relationship and who will understand your health and medical needs and provide continuity of care.
 
There are no easy answers or quick fixes to these serious problems. We can address the issues through education, communication, and services to assist the uninsured in finding programs that might help them and to assist people without a physician in finding a medical home. 
 

Monday on Dick’s World: Which Way Healthcare?

June 20, 2009
Doctor in St. Augustine, Texas giving Typhoid Innoculation in 1944, Photogrpah by John Vachon for the United States Farm Secuirty Administration

Doctor in St. Augustine, Texas giving Typhoid Innoculation in 1944, Photograph by John Vachon for the United States Farm Secuirty Administration

Recently, I went to Fort Lauderdale to see my grand-nephew Gibson Gray graduate from med school.  It was very satisfying to see him get that diploma, and the family had a great time celebrating the event with a Ft. Lauderdale vacation, but the event also brought home the fact that he is going into a profession that is in trouble.  That’s because healthcare in the United States is in trouble.

  Americans are not satisfied with the state of healthcare;  they list it right up there with the economy when asked about what concerns them most at this juncture in history.  The keynote speaker at Gibson’s graduation took the issue head on and got a lot of applause for eome of the things she said, but she also got some pregnant silences for some of the other things.  The subject is, as you know, very controversial. 

Monday, I will be getting into the issues that she raised.  Join me, and please don’t hesitate to give me your opinions.  Just click the “comment”  button and tell us how you feel.

The Graduate

May 31, 2009

This was a very special graduation season for me, and I attended a very special graduation and celebrated it in novel, and most enjoyable way.  I’ll get around to the celebration in another blog post, but for now we’ll concentrate of the graduation and what medical professionals face in the future. 

Nova Southeastern University Healthcare Professionals Division 2009 graduation, Ft. Lauderdale, Florida

Nova Southeastern University Health Professions Division 2009 graduation, Ft. Lauderdale, Florida

I said this was special graduation for me. It’s always special when a family member you have known from birth gets to put “Doctor” in front of his name.  I flew from Columbus, Georgia to Ft. Lauderdale, Florida to attend the graduation of my nephew Gibson Gray – well, he’s actually my grand nephew since he is the son of my niece Janet Sue Gray – from the medical college  of Nova Southeastern University.  

As I sat with Gibson’s mom and dad, Janet Sue and Gordon Gray, his brothers, Schafer and Taylor, and his wife Catherine, I felt, with them, a great sense of elation.  I mean,  doing what it takes to become a physician is quite an achievement – and who doesn’t want to be able to say, “my son, the doctor,” or in my case, ” my nephew, the doctor” ?

Gordon, Janet, Catherine, Schafer, and Taylor Gray, Nova Southeastern University Graduation, Fort Lauderdale, Florida

Gordon, Janet Sue, Catherine, Schafer, and Taylor Gray, Nova Southeastern University Graduation, Fort Lauderdale, Florida

It is a tremendous acheivement, considering all of the years of study, and the tremndous costs – the majority of medical students have to  get student loans running into the hundreds of thousands of dollars – that it takes to get a medical degree.

Dr. Gibson Gray, Uncle Richard (me)

Dr. Gibson Gray, Uncle Richard (me)

Well, by George, our Gibson did it, and we are all bursting with pride.  He is not through yet, though. Now he has to do three years of residency in a hospital.  He will get paid, but it is a very low salary, and he won’t be able to pay back any of the loan until he finishes that.  

Naturally, he and his family, and all of the medical graduates and their families, are keenly interested in what will happen to healthcare in the United States.  It’s for sure that something is going to happen.  The American people put it at the top of their list of concerns about the future.  Costs have gone out of sight. 

The issue was not ducked at the Nova Health Professions Division graduation ceremony. It was squarely faced by Florida Democratic Rep.  Debbie Wasserman Schultz, the keynote speaker.  We’ll look at that it in a future post.  Stay tuned.

How We Can All Improve Our Bedside Manner

April 26, 2009
Dr. Brian Wong, The Bedside Project, at Rotary Club of Columbus, Ga (Photo courtesy" Jim Cawthorne, Cmaera 1)

Dr. Brian Wong, The Bedside Project, at Rotary Club of Columbus, Ga (Photo courtesy: Jim Cawthorne, Camera 1)

Our lives are determined by conversations,  what people say to one another,  and the choices people make when deciding on how to respond to another person’s words.  Dr. Brian Wong of the Bedside Project,  brought that home during a talk to to members of the Columbus Rotary Club.  (His appearance was sponsored by St. Francis Hospital.)  It’s the sort of thing that he tells physicians when he is coaching them on how to improve their bedside manner by proper communications.

He used film clips of the movie Gettysburg   to make his point.   Colonel Joshua Chamberlain was faced with dealing with 120 members of the 20th Maine regiment who had mutinied and refused to fight at Gettysburg.  Wong played clips from the movie showing how Chamberlain responded to remarks made by angered mutineers.   He would stop the film and ask the Rotarians to turn to one another and say what they would have said if they had been the colonel,  then he played Colonel Chamberlains response, which was usually the opposite to the first blush immediate reactions by the Rotarians.

Turns out that Chamberlain won the men over by the way he handled the situation. The picked up their muskets and join the famous bayonet charge that defeated Southern troops at Little Round Top.  He did it, according to Dr. Wong by expertly using the space between stimulus and response.  In other words when someone says something to you, that is the stimulus, and the space between that and your response can make a lot of difference. 

Instead of reacting immediately to disrespectful and insubordinate remarks by a spokesman for the mutineers,  he would pause before he spoke,  and then say the opposite of what an immediate, also angry would have been.  It disarmed the mutineers, and he gave a speech – maybe the Hollywood version in the movie had some truth to it, though no one seems to know how much – that inspired all but a few of the men to pick up their muskets again and join in the fight.

The lesson of Dr. Wong, “Use that space before you respond, and, quite often,  it will be the opposite of what you would have said if you had not used it, and the outcome can be much better.”  This is the sort of thing he teaches doctors in inspiring them to improve their relationships with their patients.  I guess it boils down to “look before you leap” and “think before you speak,”  if we put it in terms of well-worn proverbs.