Holes in the Net

Above: The hustle and bustle of Interstate 75/85 in Atlanta, aka the "Downtown Connector." Courtesy Wikipedia.

"ATLANTA CAN'T LIVE
WITHOUT GRADY."
From the Grady Health System main page.

Although health care is a quintessential part of society today, the 2008-09 recession has shown that money could still be more powerful. One example: Grady Memorial Hospital of Atlanta was about to be closed in 2008 after gathering $53 million deficit, produced due to the hospital's dedication to taking care of those disadvantaged for health care in the region. However, with the following statistics showing how crucial the hospital is to the area, it would seem that closing should have not been an option:

1. It takes in 850,000 outpatients and 30,000 inpatients each year.
2. It has Georgia's only Poison Control Center.
3. It is the area's only Level 1 Trauma Center
4. It is Atlanta's main safety-net hospital.
5. Its network includes Grady Memorial Hospital and 9 more area community clinics.

In the New England Journal of Medicine, Grady Memorial Hospital was featured in an article about the holes appearing America's current safety-net.

Okay, pause for a second.

For those of you unfamiliar with the concept, a safety-net hospital is a hospital that serves a significant amount of low-income, uninsured, and disadvantaged populations. One thing that really surprised me about the definition of a Safety Net, is that ownership (public or private), isn't really the factor, but other determinants, from philosophy (e.g. having an "open-door" policy for care) to usage (i.e. proportion of incoming patients with low-income or proportion of people who utilize medicare). Most of these hospitals are eligible for what they call Disproportionate Share Hospital (DSH) payments from the government, which aid the hospitals for the costs of providing uncompensated care to those uninsured or under insured.

Whew.

Fortunately, with private donations and grants, the hospital was able to stay for the most part, open. The dialysis clinic at Grady was forced to close. Grady has done much for its patients to assign them to temporarily set them up with other clinics and to help ease transitions for those patients struggling. Although the damage to the hospital itself was minimized, there were patients that were still critically affected by the situation.

Closer to my neck of the woods, the main Safety Net Hospital of Chicago, John H. Stroger, Jr. Hospital of Cook County, is a refuge for those without health insurance benefits. According to a September MSNBC story, these disadvantaged patients are very happy to have some place to go. However, recent health care reform may reduce DSH payments to hospitals such as Grady and Stroger, potentially weakening important links in our health care system, leading to reduced coverage and maybe closure for some institutions. We've seen already how financially tight things are at Grady, for all I know there could be another handful of hospitals that are teeter-tottering in the same financial situation.

To me, the idea of losing funding for these hospitals could be disastrous. Personally, I think that its dangerous to cut funding from these hospitals, as health care for more than the low income could be affected. One hypothetical situation that I thought of is if these high capacity hospitals are closed, where else will these people go? Potentially to other hospitals that are not prepared for the added patients, stressing the rest of our health network in America. A unseen domino effect might be on the horizon.

I personally think that there are other options that are not being looked over, such as tort reform (e.g. protecting doctors from suits, so we can work more efficiently without having to worry about our backs) and many inconsistencies and inefficient ways that medicare and medicaid are being provided. Sometimes I think that the government is attempting to do so much to health care right now that if something goes wrong, we won't be able to figure out what made it go wrong, due to the extreme complexity of our health care system.

Like I said a couple of months ago: I'm all for reforming the system, but we need to be careful and think about all the potential consequences of our decisions in the long term. It concerns me that things that may appear to be good for us now might not be good for the next generation.

Sources:
1. Forum on Displaced Grady Dialysis Patients Held. Atlanta Progressive news. December 7, 2009.
2. The Grady Health System main page.
3. Redlener, I. and Grant R. America's Safety Net and Health Care Reform - What Lies Ahead? The New England Journal of Medicine. December 3, 2009: 2201-2204.
4. Will safety net hospitals survive health reform? MSNBC / AP. September 8, 2009.
5. What is a safety net hospital? National Association of Public Hospitals and Health Systems.

Valuable Talents

Above: A former Cuban doctor continues his medical career as a nurse in the United States. From The New York Times, Maggie Steber, 8/4/09.

MORE PROOF THAT ANYONE WOULD DO ANYTHING
FOR A DREAM.

January 2009. I remember that one thing that struck me about the medical staff of Princess Margaret Hospital in Dominica was that the doctors were not just of Dominican descent. In addition to working with the natives, I also worked with a few Cubans, and not to mention an American, and a Filipino (that's luck!). I remember asking one of the Dominicans where he got his medical degree, and he told me that many of the Dominicans really don't go to Ross, but they head to Cuba to get their education. I'm guessing this partnership in medical education explains why many Cubans also found a place in medicine in Dominica.

August 2009. The New York Times featured in their Tuesday Science & Health section, an article about doctors who are fleeing from the political oppression in Cuba and heading for a life in medicine in the states. However, many of these doctors face the challenges that many IMGs face: a language barrier (see my previous IMG entry below) and board examinations that might feature knowledge that outdated textbooks in the Cuban system lack. I really enjoyed former doctor Carlos Domínguez's story about how he traveled to the United States in a boat that didn't have a reverse gear, because he knew he was never going to return to Cuba.

Working with the Cuban doctors during my fifth semester was quite a treat. When working with them, their enthusiasm for the field of medicine definitely showed through their willingness to teach (along with their patience for a set of medical students just bound to mess up). When observing one surgeon perform a hysterectomy, I can clearly remember how excited he was when he saw the patient's fibroid (an abonormal mass originating from the smooth muscle of a woman's reproductive system), and his eyes lit up exactly like a little kid in front of a candy store. After student presentations, the Cuban doctors were more than willing to announce their praise for the students and for the work that went into it.

I absolutely enjoyed working with the Cubans.

The thing I respected a lot about the doctors I worked with was their excellent bedside manner and the ability to speak with them on a first name (okay, semi-first name, because they had us put the doctor title in front of their first name) basis. They also were more than willing to crack jokes left and right to keep the mood light - for patients and for students. For me, it doesn't jive well that doctors from Cuba making it to the U.S. (many of them with great experience, work ethic, and strong motivations) are ending up not working at the level their title, and instead working in other positions in health care (e.g. nurses). Some even go on to work in other unrelated fields.

I understand that coming to the states for freedom is a dream... but there has to be a way for these doctors to be utilized. There's definite potential.

I don't know, perhaps this is a "Hail Mary" idea, perhaps they could be a part of a solution to cure our shortage of primary care physicians? From my experience, they do have the knowledge, the passion, and the ability to be a part of our American Dream of good health care. I don't think that their talents should be wasted; instead, I believe their talents should be refined.

Source: The New York Times

Soundbytes

Above: President Obama reading letters in the Oval Office regarding HealthCare. From www.whitehouse.gov, August 4, 2009.

AN AVERAGE TV NEWS BYTE IS
120 SECONDS.

Usually, I'm a fan of the quote, Time is of the Essence. However, with the recent news on health care, I see rushing the issue could be bad... very bad.

I remember being told that the average soundbyte on the news is only about 2 minutes long (after watching today's midday news, I believe it is even shorter). And, with all the news stirring about health care reform, how much can the American people be enlightened with the pros and the cons of the current bill that's being transferred into congress. I'll be honest, with the free time that's been given to me post-examination, I've been digging left and right, trying to find the core of what the bill is and why is there such a rush.

I've started reading up articles online from the New England Journal of Medicine, the New York Times, various websites stating the democratic and republican points of view upon the issue, and even rewatching President Obama's hall conference had on ABC a few weeks ago. To be truthfully honest, it seems that not everyone is addressing the same points, although there might be some overlap, and I find it rather irritating when I can't answer the question, What did the other side think?

I believe that health care is such a complex problem, that there's potential that fixing one thing might lead to exasterbating other problems that might not have been thought of. But something needs to be done.

I respect the president's goals with health care and the viewpoints too, but if I'm a medical student who's been trying to follow this with simply newsbytes, even with question and answer sessions, and now has gone to lengths to start digging for information, YET still has NO idea what the overall costs and benefits of this legislation is, what is it for millions of other Americans who are getting concerned, with only time to get their info through soundbytes? I want to make sure I'm eduated on this issue too, and I hope that my representatives and senators are making educated decisions too.

Healthcare policy is critical for everyone's lifestyle, their budgets, and of course, our economy.

Hopefully with this August recess, I can do that, but I hope that the Government slows down. However, the president is right: we need a deadline (however, realistic) or nothing will get done.

But for now, the digging continues. Soundbytes aren't enough.