The TAP-IN Blog

Caregivers and Patients Tell Their Stories in New Online Magazine

It's brand new to the web. Appropriately, it's called Pulse and, as it describes itself,

Pulse is an online magazine that uses stories and poems from patients and health care professionals to talk honestly about giving and receiving medical care.

Pulse is also an online community, a chance for patients, doctors, nurses, social workers—everyone—to come together, share our experiences in health care, and explore our common wish for a humane system of health for all.

Pulse invites high quality submissions of stories and poems by "patients, caregivers, doctors, nurses, social workers, therapists, students and anyone else who wants to share his or her experiences of giving or receiving health care."

It's not hard to imagine that there are plenty of stories and poems that could be written about medical volunteerism, being uninsured and being cared for at a free clinic.

A Clinic Fights to Keep Providing Services

There are heroes out there, across the country, who simply won't stand for people not having options for health care. They sacrifice their own time and their own savings and financial security so that people more unfortunate than them can at least get some medical attention for themselves and their children.

Many regions in the U.S. have growing populations of families and individuals barely able to cover the essentials of housing and feeding themselves, much less paying for health care. In such areas, medical and health care services see little potential of profit, so they don't build facilities and don't provide services. Into the gap come free clinics or - in the case of West Valley, Utah - self-supporting clinics that serve both the completely uninsured and those who can pay through an insurance plan or Medicaid.

The WestView Community Health Center is "always near collapse due to short funds, and in the current slow economy, the clinic is seeing more patients while earning less money," as reported in the Salt Lake Tribune. LaRohnda Dennison and her mother, Goldie, founded the clinic after recognizing the lack of coverage in the West Valley area. They converted their medical billing service into a clinic that provides insurance counselling to its patients. But as the number of uninsured patients rises, the income from the barely insured is proving to be less than operating costs.

The clinic averages between 125 and 150 patients per day, many of whom lack insurance.

"We don't turn anyone away," LaRohnda said.

That means the $250,000 it costs to run the clinic each month comes from those few patients who do have insurance or Medicaid. The clinic has a financial counselor on hand to see if patients qualify for public assistance, but many are put on a sliding-fee scale and just pay what they can.

Maribel Huanco recently visited the clinic when her 18-month-old son, Mark, had a cold and fever.

Huanco lacks insurance, and said through an interpreter she could not afford health care for her three children without the clinic. She feels very comfortable with the Spanish-speaking staff, and believes even though the care she receives is inexpensive, the quality is second-to-none.

Huanco also received prenatal care at the clinic, which is one of the greatest areas of expense. The clinic employs two obstetricians, who each deliverabout 35 babies each month.

LaRohnda Dennison said the clinic could save thousands by stopping prenatal care because medical malpractice insurance is so high for the specialty, but she knows continuity of care leads to healthier pregnancies and healthier babies.

Many of those infants keep coming to the clinic after birth. Matthew Agresta, a family practice physician at the clinic, estimates 70 percent of his patients are children.

He sees between 20 and 30 patients each day, and treats a wide range of ailments. Much of his time is spent on well-baby care and other pediatric checkups, but he also removes moles, places IUDs and performs circumcisions and vasectomies.

To save patients money, the clinic's doctors perform many procedures that would normally be done by specialists.

Another challenge for Agresta and the other doctors is uninsured patients tend to wait longer before coming in for treatment. The doctors often see more advanced disease progression, which is usually harder to treat.

Follow-up visits are also difficult, because many patients are hard to track, not knowing their birth date and lacking a home address or phone number.

Primary Care Doctors Planning to Quit or Cut Back

Almost half of U.S. doctors surveyed by the Physicians' Foundation responded that they feel overworked to the point that they're ready to reduce their patient load or leave their practice completely. Sixty percent of the 12,000 doctors surveyed said they would not recommend medicine as a career. As the Reuters story reported:

"The whole thing has spun out of control. I plan to retire early even though I still love seeing patients. The process has just become too burdensome," the Physicians' Foundation, which conducted the survey, quoted one of the doctors as saying.

The survey adds to building evidence that not enough internal medicine or family practice doctors are trained or practicing in the United States, although there are plenty of specialist physicians.

Health care reform is near the top of the list of priorities for both Congress and president-elect Barack Obama, and doctor's groups are lobbying for action to reduce their workload and hold the line on payments for treating Medicare, Medicaid and other patients with federal or state health insurance.

Adding to their frustration, more than 90 percent of the respondents said that they've had to devote more time to non-clinical paperwork has increased in the last three years. Almost two-thirds of them blamed that for their having to spend less time with each patient.

Eleven percent said they plan to retire and 13 percent said they plan to seek a job that removes them from active patient care. Twenty percent said they will cut back on patients seen and 10 percent plan to move to part-time work.

Seventy six percent of physicians said they are working at "full capacity" or "overextended and overworked".

Hard Times

Washington Post reporter Travis Fox took a month-long trip around the United States to see how Americans were coping with the economic downturn and how it was influencing their votes in the election. He chronicled his journey in a weblog called "Hard Times" and accompanied his writing with video clips.

In this article titled "Uninsured Consequences", Fox visits Vicki Zeoli in Altoona, PA, and talks to her and her volunteer doctor at the local free clinic about her circumstances and those of the other uninsured people dependent on the clinic's services.

Zeoli’s doctor, Zane Gates, has recently seen a “dramatic increase” of people like Zeoli seeking free medicine in the clinic.

“When I first started, it was mostly people who had been suddenly unemployed,” he said. “Now it’s mostly the employed. With the economy getting worse and worse and worse that number is going to skyrocket.”

Reducing ER Costs in New Hampshire

The solution - according to Caroline Steinberg, the American Hospital Association's vice president of trends and analysis - will not be found just in adding more clinics, primary care physicians and nurses. She told the Foster's Daily Democrat in New Hampshire, "We need a broad-based health care reform that covers everybody so everybody can get access to health services."

And yet, New Hampshire strives - like many other states - to stem the tide with expanding clinic services to take pressure off of hospital emergency rooms where too many of the uninsured are forced to seek care at an increasing cost to all.

According to the American Hospital Association in Washington, D.C., the cost of uncompensated care at the nation's hospitals increased from $3.9 billion in 1980 to $31.2 billion in 2006. It also has made up a rising percentage of hospital operating costs, from 5.1 percent in 1980 to 5.7 percent in 2006.

The Avis Goodwin Community Health in Dover and Rochester, one of New Hampshire's 14 community health centers, treats 8,000 patients, 48 percent of whom have no health insurance. These ranks are growing as people lose their jobs. Medical services are covered by three primary care physicians and three nurse practitioners.

More community health centers are needed, and they need to be properly staffed so people can have regular access to primary care physicians to help monitor and maintain patient health, she said.

Avis Goodwin offers a sliding fee scale to help people pay for services. Avis Goodwin also offers free services for homeless people and payment plans of as little as $5 per month, Atkins said.

The clinics are open Monday to Friday, 8 a.m. to 5 p.m. The Rochester clinics are open until 6 p.m. on Thursday, and the Dover clinic is open until that time on Tuesday. People also can call an after-hours emergency number to speak to a nurse.

The Need for Clinic Volunteers Grows Ever Greater

The prognosis for what's left of the health care system in this country is not good, and looks even worse for those without insurance. Not since the days before modern medicine have we been in such need of more practicing physicians, nurses and dentists.

In a pre-election day column about the multiple problems that the incoming U.S. President will face, Bob Herbert of the New York Times quoted one of Obama's top health care consultants and President of the Children's Health Fund, Dr. Irwin Redlener, about the crisis of the uninsured in America.

“First of all, at least in the short term, we can expect more families will become homeless as foreclosures continue to mount and jobs become harder to hold and more difficult to find. As jobs disappear and employers begin trimming expenses, we can foresee people losing health insurance, swelling the ranks of the medically uninsured.

“I don’t think the health care system can bear another five million or more people uninsured and economically fragile. More people without insurance will crowd into the nation’s hospital emergency rooms when medical problems become too severe to ignore or there is no other access to basic health services. Such a trend will have a seismic impact on our health care system.”

Herbert went on to describe the fast-deteriorating situation of hospitals in general.

Few Americans have noticed, but a tremendous number of hospitals, from Boston to Los Angeles, are in serious, even dire, financial trouble. A survey of 4,500 hospitals by the New York consulting firm Alvarez & Marsal found that more than half were technically insolvent or at risk of insolvency.

The current economic downturn, combined with an anticipated surge in patients without health insurance, will only worsen what is already a crisis.