Volume 61, Number 3 - Summer 2010

 

By Steve Osborn

A: I played a lot of soccer and was very active in Girl Scouts, and I showed horses in 4-H. Our neighbors had a barn right behind us, and I would work on their farm in exchange for riding their horses. I never had my own horse, I just worked at a farm where I got to have unlimited riding ability.

A: I was five years old and fell off my bike, and I had to get stitches. I distinctly remember a man in scrubs stitching my hand and watching him. The nurse had wanted to tie me down, and my mom said no, you won’t have to do that, she’ll be calm. I remember watching the man sew up my hand, thinking this is so cool, this is what I want to do when I grow up.

A: Pretty much. I never really thought of doing anything else.

A: I think it is a great first start. We definitely need health reform, but the current bill seems to be more health insurance reform rather than health care reform. It is not really reforming how we offer and look at health care in general. 

A: What we need to focus on is primary care and prevention of diseases. Our current medical system pays well for doing procedures, seeing lots of patients, and fixing something once it is broken. Instead, we need to focus on basic, simple things—like childhood obesity, exercise, and healthier lifestyles. We also need to look at alternative ways to deliver health care by maximizing technology rather than the traditional doctor’s office visit.

Q: The main problem that one hears about on the provider side is containing costs. How would a focus on prevention contain costs?

A: If one can prevent diseases from occurring, we are going to have really large cost savings down the road. It’s not high-tech or sexy, but by simply controlling hypertension and hyperlipidemia we can prevent heart attacks and strokes and help our patients live longer and healthier. But, to truly have health care reform, we need to have medical schools turning out more primary care physicians. We also have to decrease the cost and debt that medical students have when they get out of school, because it really deters a lot of physicians from going into primary care. 

A: That is something that definitely needs to be examined. The current bill increases primary care reimbursement by 10%, but I think we need to look at the overall picture of the quality of care delivered. We need a system that will accurately track preventive services like mammography, pap smears/HPV testing and colon cancer screening.

A: Absolutely! Instead of just being rewarded for fixing a problem once it has occurred, we should really reward physicians for keeping their patients healthy and out of the hospital.

A: What I’m really excited about is people who have preexisting conditions will be able to purchase health insurance, and that insurance companies will not be able to drop their patients or rescind medical care because of conditions that they have.

A: I know I will be busier. In the community, the increase in Medicare and Medi-Cal reimbursements will help physicians so they can stay in practice. The reforms will also provide more funding for the community health clinics.

A: The new health care bill is incredibly long and complex, but I think it really is a good first start. I truly believe that health care is a right and not a privilege. Every American should have health care coverage.

A: We need to correct inequities for physician payment in different geographic areas. In Sonoma County, for example, we are still under-reimbursed for the actual cost of providing medical care. That’s something the government really needs to look at. 

Also, I believe that evidence-based medicine should be practiced, not to ration care, but to do the correct test or procedure that will really help the patient have a better health outcome. We in the United States spend more money per patient with worse quality outcomes. I encourage everyone to read Atul Gawande’s article “The Cost Conundrum” [New Yorker, June 1, 2009]. It is an eye-opener. 

A: I’m the women’s health liaison and domestic violence champion at Kaiser. One of my goals as president of SCMA is to bring more awareness about domestic violence. Physicians need to be more aware of domestic violence so they can recognize it in their patients.

A: Definitely. Twenty-five percent of women will suffer from some form of emotional or physical abuse during their lifetime. Physicians tend to think that it only happens to somebody else’s patients, but I encourage all physicians to ask their patients about it. Domestic violence is most common in young women 18 to 24, and in women who are pregnant.

A: Yes, and it isn’t any more difficult then asking other personal questions. Even if everything is fine at home, women appreciate the concern. Asking an open-ended question about her relationships and how things are at home can allow your patient to get help and get out of an abusive relationship.

A: Prevention, making sure my patients get the health screenings they need. Also, 50 percent of pregnancies are unintended, but not necessarily unwanted. I am focusing on preconception care and working on a program at Kaiser Permanente for women to develop a “reproductive life plan.” A healthy mom has a much better chance of having a healthy baby.

I also want to ensure that young women have adequate access to birth control. With the county closing down the Family Planning Clinic, that is going to be a barrier for a lot of teens to get contraception. I hope physicians will work with their teens to get them what they need confidentially.

A: We have had several of the residents from the family medicine residency coming to SCMA meetings, and a lot of input from them, but we definitely need more. The face of medicine is changing, and I think that young physicians really need to step up and get involved so their voices can be heard. A lot of the physicians who are currently involved are significantly older and are looking at retirement in the next 10 years. We need new blood, new ideas, and more energy.

A: I think it offers them a voice. They can change things that happen in their own hospital or their community. But if they don’t voice their opinion and get involved, other people will make the decision for them.

A: I think physicians in Sonoma County are very collegial. Many physicians from Kaiser and the community are working together with the residency program. One of the things I really want to emphasize is that it’s not an “us” and a “them.” We’re all here to take care of our patients, and I think whatever mode of practice someone wants to do should be respected. I have been in both private practice and now with Kaiser, and I have a deep respect for all my colleagues in medicine.

A: Yes. One day I saw a patient in the hospital who was 98 years old. He was dying of pneumonia, and later that day I saw his great granddaughter. That was so meaningful to me to care for four generations of his family—to see his great-granddaughter and get her ready to start kindergarten, and to be at his bedside at the end of his life. I really like that continuity, taking care of multiple generations of the same family. To me, that’s what medicine is about, being able to be there for your patients. Not always being able to cure, but certainly being able to 

comfort.