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Notes from the ER
Dr. Joe Pellicer works in the Emergency Center at Providence St. Peter Hospital. Dr. Tom Burke is the director of the Center for Global Health at Massachusetts General Hospital and a Harvard University faculty in emergency medicine. Please go to www.notesfromtheer.com for more information or to contact the doctors.
LIVING COLUMNS
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Letter to president-elect on health care
Dear Mr. President,
Congratulations on your victory! We are excited by the possibility that you can lead this country in a new direction. We would like to share a few thoughts for you to consider with respect to your health care policy.
To introduce ourselves, we are two emergency physicians. One of us works in a busy community hospital on the West Coast, the other teaches at Massachusetts General Hospital and leads its international health efforts.
Obviously, we have a big mess on our hands. Along with our colleagues, we see a two-tiered health care system that, for all of its technical prowess, is hopelessly mired in a sea of inefficiency, misallocated resources and proven incapacity to provide care for millions of our citizens.
We believe you share our view that the situation is a disgrace. It is an international embarrassment for this wealthy country that so many of our citizens get their so-called heath care in emergency departments. While we emergency docs have many skills, counseling people on how to prevent illness or how to best care for their chronic illnesses is not our expertise.
As you have observed, our system is costly, not only because it is used very inefficiently but also because of the hidden billions in decreased human productivity when health problems are not managed proactively. This doesn't even take into account the later cost of medical care for conditions that could have been prevented.
The sad fact is that the federal health care programs, Medicare and Medicaid, are broken. They do not offer adequate compensation. The majority of primary care physicians and specialists either do not accept or severely limit the number of these program recipients into their practices.
There are alternatives to this situation: One is the system you have put forth - basically mandating and subsidizing private health care insurance. This clearly will work better than what we have now, but it will be expensive and will not change the underlying system that rewards physicians for treating illness more than preventing it.
Here is a different idea that we would ask you to consider: Support the rebirth of a vibrant public health system. Not a universal care plan, but a system of federally funded, locally administered public health clinics and hospitals that offer a valid alternative to the private system.
Many of these institutions already exist but often are severely overburdened, understaffed and underfunded. They often are the domain of altruists, academics and doctors in training.
The unfortunate reality is that few of those doctors stay on because the choice of working in a public health clinic or hospital instead of a private practice almost always involves a significant cut in pay and challenging conditions. It is time to end this inequity.
New doctors should WANT to work in the public sector, not only because of the challenge and mission, but because they are exciting, efficient places to work that also pay well. We would go so far as to suggest that federal student loan programs demand repayment in service.
Public sector health care jobs should actively compete with the private world. Some capitalist purists will cry foul, but we have seen what the result is: millions who do not get decent medical care. Instead of subsidizing private insurance, why not spend that money on high-quality public care.
There already are models for this and some work very well. These institutions should be centers of excellence where medicine is practiced the way it should be, unhindered by the distortions that come with meeting corporate bottom lines.
Obviously you have your work cut out for you, and health care is only one issue with which you have to contend. We want you to hear that we understand that this process is going to take time and patience and a willingness to be open to new ideas.
After enduring the past eight years of a government that seemed to care so little about the health of this country, we are looking forward to supporting your efforts to move our country toward the goal of providing quality health care for all of its citizens.
Sincerely,
Joe Pellicer, M.D. and Thomas Burke, M.D.
Today's column is by Dr. Joe Pellicer, who works in the Emergency Center at Providence St. Peter Hospital, and Dr. Tom Burke, who is the director of the Center for Global Health at Massachusetts General Hospital and a Harvard University faculty in emergency medicine. The thoughts and opinions expressed are their own and do not necessarily reflect Providence Health & Services. Go to www.notesfromtheer.com.
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Little fingers, toes and an outpouring of love
Last week, I supervised the pediatrics emergency room at the Massachusetts General Hospital in Boston. Each patient in Boston reminded me of my patients far away: mothers, fathers and children smiling, laughing, crying, hoping and dreaming.
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Little fingers, toes and an outpouring of love
Last week, I supervised the pediatrics emergency room at the Massachusetts General Hospital in Boston. Each patient in Boston reminded me of my patients far away: mothers, fathers and children smiling, laughing, crying, hoping and dreaming.
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Solving puzzle of the confused parent
"Mom's been hallucinating a lot," they told me, "We're wondering what we can do about it."
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Smoke, mirrors and immunizations
The call came from an emergency room just north of the city. It sounded routine at first. Sometimes our region's practitioners ask for rather straight-forward advice; other times, we are equally stumped. I'd rather be called too often than not enough.
