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Commentary: Family doctors vital to health reform


Dr. Scott Morris is the founder of the Church Health Center in Memphis, Tenn., which provides affordable medical care for the working poor and homeless in the area.
A UMNS photo courtesy of Church Health Center.

A UMNS Commentary
By Dr. Scott Morris*

June 17, 2009 | MEMPHIS, Tenn.

For 22 years, I’ve worked as a family practitioner and executive director of the Church Health Center, a faith-based medical-wellness clinic, for the working uninsured in Memphis, Tenn. During this time, I have developed a clear picture of where health care in America has gone wrong.

There are three central drivers that contribute to our current crisis – and all of them are related.

“To deliver good health care in America, we don’t need fancier gizmos that will give us a prettier picture.”

The first is an irrational love affair with technology. We are creating a tidal wave of physicians who rely on the results of expensive fancy tests rather than our own medical training and experience to make a diagnosis. By ordering more and more MRIs and fancy scans, we are sending the message (and the dollars) that the basic requirement for competent medicine is bigger and better technology.

But that’s not true.

To deliver good health care in America, we don’t need fancier gizmos that will give us a prettier picture. Our medical technology is the best in the world. Rather, we need to direct our resources toward training physicians who will treat patients on the front lines here at home.

Secondly, the reimbursement schedule is far more profitable for surgeons, radiologists and the like, who can justify scheduling a disproportionate share of technological tests. It certainly doesn’t reward the physicians who use their minds to diagnose and treat patients, as was once expected of a skilled family physician.

It’s no surprise that few young doctors are choosing careers in general medicine. Case in point – this year’s graduating class at the University of Tennessee’s Medical School will have 22 students entering radiology residencies alone as opposed to 23 entering primary care residencies (family practice, internal medicine and pediatrics combined). Radiologists work fixed hours and are well paid. Primary care doctors work long hours for significantly less. This begs the question, “Who will take care of us? And who will care for our children?”

And lastly, we are dependent on technology; our focus is on eradication of disease. Promoting health and disease prevention is an afterthought.

Focus on prevention

At the Church Health Center, if you want to become one of our patients, you must participate in our wellness program. We insist that our patients be active partners in their care, or we simply cannot ask our donors and volunteers to support their critical care needs.

“ Giving 50 million uninsured Americans access to a broken system will not make our country healthier. ”

Health care reform will not be achieved by finding a way to pay for our current system. Giving 50 million uninsured Americans access to a broken system will not make our country healthier.

The intellectual and monetary capital that has been spent on enhancing technology must be directed toward developing true prevention models for the community. The issues of obesity and sedentary lifestyles, poor nutrition, and dysfunctional ways of coping with stress must be regarded as equal.

We must also address our moral failure when dealing with end-of-life issues. More than 25 percent of medical expenses come in the last six months of life. And it’s not uncommon for 80 percent of a person’s medical costs to be spent in the last six months of his or her life.

These overarching goals can be implemented with the following changes:

  • Provide health care for all children. The recent passage of Children's Health Insurance Program, when fully implemented, will leave 5 million to 6 million children uninsured. This number doesn’t include immigrant children. All children in America should receive the same standard of health care.

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  • Extend Medicare to begin at age 55. This would help us treat problems like diabetes and hypertension early in their course, rather than waiting until we are treating the end result – heart and kidney disease – which comes from years of neglect.
  • Change the formula for physician and hospital reimbursement. Reward primary care providers and health care institutions who focus on disease prevention.
  • Insist that the National Institutes of Health focus on disease prevention. Encourage community-based research on disease prevention.
  • Implement national quality measures. Measures advocated by organizations like the Institute for Health Care Improvement will help us track program efficacy.
  • Digitization of records can be taken in steps. After two years of our clinic being totally electronic, I’m convinced that digitizing American health care is not as critical to health care reform as some believe. The current system contains many flaws, and the kinks need to be worked out before we can trust it in our medical practices.

The proposed health care reform would still leave 20-25 million people uninsured. The difficult question is not whether there is enough money to pay for health care. Rather, is there enough political will to change the focus from one of fee-for-service to a community-central system that celebrates life?

One thing remains key: The church needs to be proactive in making our faith communities healthier in body and in spirit.

*Morris is a family physician and executive director of the Church Health Center in Memphis, Tenn.

News media contact: Linda Green, Nashville, Tenn., (615) 742-5470 or newsdesk@umcom.org.

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