:: to the teeth ::    thoughts on social justice, medicine, race, hope and beats

"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::

"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Thursday, April 13, 2006  

A Shocking Moment - Public Healthcare System WORKS!

it may sound from the title that i don't believe in public healthcare. let me reassure you that it's about the only healthcare i believe in. but for many reasons, our publichealthcare systems are underfunded, underperform, attract slackers, support incompetant administrators, promote yes-men and yes-women and generally focus on trying to look good instead of trying to perform good. everyone, from janitor to doctor becomes powerless to improve aspects of the system. my criticism is made with the intention of someone trying to fix the system, not destroy it.

so here's the "good" news.

i saw a young woman in my clinic two weeks ago. she is poor, spanish speaking, three kids, no papers, no husband, helped by a social worker to get to the clinic. you may have presumptions or preconceived notions about this woman and her right to even receive healthcare from that brief desciption. let me say one thing to put you in the right space: this is a lovely young woman in a difficult situation beyond her control. think of her as your sister if you have trouble recognizing that people of other cultures and nationalities are human.

she had a rapidly growing lump on her forehead but was fearful of high bills and hostile doctors so she avoided medical care. after a month, her social worker convinced her to come in and we did a fairly difficult biopsy of the lump. i was trying to maintain a minimal scar which forced me to make a very small incision along the scalp line which led to a difficult but ultimately productive procedure. the biopsy came back with CANCER. type still unknown. rare enough that it was sent to a super specialist who can help figure out if it's terribly malignant or mildly so.

we have a volunteer pathologist who helps us with these cases and he was able to get the assistance for free from this super-specialist pathologist who is one of the leading experts on this type of cancer.

while the pathology is being processed, i met with the woman and her social worker. we took about 45 minutes to break the news, process her grief and fear, answer her questions, let her know she isn't alone on this terrible journey, and start to make a plan to get her situated asap.

usually a person in her position would have avoided healthcare for many more months, but she had the social worker caring about her. usually a woman in her position would have had to wait 2-4 months for the appointment to get the biopsy done, if not longer. but we had my clinic open which does walk-in appointments on the same day a person wants to come in. usually a person in her position would have had to pay $500-$1000 for the biopsy procedure and pathology results. she got it for $60. usually a woman in her position would have had to wait another few months to get in to see a surgical specialist because the public hospital system is so overcrowded.

here's where the final piece of magic came in. i'm getting to know a surgeon at the university who is a technically excellent ENT (facial) surgeon with extra training in plastic surgery. he is a strong patient advocate, believes in the economic model of doing private practice to bring in extra money to use for uninsured poor patients. this is the officially stated economic model of our public hospital. turns out that they really like the money he is bringing in but are very resistant to his advocacy for also bringing in poor uninsured patients who need medically necessary surgeries. they are now threatening to not renew his contract, even though he is one of the only facial plastic surgeons at a level three trauma hospital in a poor state.

what is somewhat personally and historically interesting to me is that it was in an ENT clinic where i first learned about the profound discrimination going on against poor and uninsured patients at the public hospital 5 years ago, when i was a lowly resident. it was in that ENT clinic that i decided to help form an external health justice coalition that has successfully challenged the hospitals erroneous, hostile and unethical exclusionary policies and theoretically had those policies changed (on paper). fast forward five years and here the situation reveals itself how little functional progress we have made that this surgeon, as a patient advocate willing to work for free, bringing in good private money to the system, is being pushed out for his work, and cannot get patients the surgeries they need. so much for changed policies. this is a lesson in social justice. the policy on paper is 10% of the battle. the implementation of that policy is where the heart of the work is.

well, he hasn't been pushed out yet. many hospital employees and the health coalition are backing him up to ensure that he gets a fair trial and hopefully a new contract.

so it turns out that he is the exact surgeon that this woman needs to resect her cancer and give her a good cosmetic result. i called him on his cell phone. he answered, was great to talk to, accepted the patient without question of her insurance status and she now has an appointment with him in 1 week to figure out what needs to be done. which is perfect timing because we are still waiting for the final pathology results.

this woman, while she is struggling with a potentially terrible medical situation, has had the blessings from good hearted people who have created a simple pathway for her to definitive medical care with minimal cost, humiliation, friction, invasiveness. basically, she has been treated like a human being, with care and concern.

i am proud to have been a part of her journey thru the public healthcare system, which is something i cannot often say these days when i have to reach outside of my own little clinic.


posted by andru | 4/13/2006 10:54:00 PM | (2) comments |

Saturday, April 08, 2006  

Country Boy...

yesterday i had a great time. i rented a large trailer, hitched it up to my veggie oil burning diesel pickup truck, drove over to another town and picked up a donation of 5 antique (used) medical exam tables. had to load them with the help of the medical assistant. he just kept saying, "see, if you have a Mexican you can do anything." i kept trying to respond, "hey, what am i, chopped liver, it helps to have a Jewish doctor also!" i was grunting those 500 pound tables right next to this dude. :>

but the really fun part was learning how to drive in reverse with a trailer. finally, all those years of organic chemistry helped! trying to imagine what direction that trailer was going to try to go in based on the direction i turned the wheel, it felt like inverted logic and fischer projections.

unfortunately, the only thing doctors really want to get rid of are older exam tables and the oldschool scales so i'm full up on those items and am starting to outfit other free clinics and independent doctors.

now, a new opportunity is presenting itself. a local hospital, owned by a multinational dork corporation, is threatening to close. too many poor people, not enough profit. i'm wondering what they are going to do with all their older medical supplies and i'm sending in agents to see if we can't capture some of their stuff before they throw it away. companies like that almsot never take the time to recycle or donate their equipment. it's more efficient to haul it all to a landfill.


posted by andru | 4/08/2006 09:28:00 AM | (1) comments |

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