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Tuesday Jan 29, 2019

Don't Be Shy About Asking for Help Patients Need

Physician burnout results from multiple factors, and not every physician who suffers from it experiences it for the exact same reasons. But one common contributor likely is the anger and hopelessness we feel when we can't help a patient.(www.healio.com)

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Sure, we get tired of working ridiculous hours and spending the majority of our time doing computer-related tasks(www.forbes.com) that feel like hoop-jumping rather than life-saving. But the hit that is hard to rebound from is failure.

And failure is often not within our control.

I have no control over insurance formularies, no control over a patient's income or housing, and I definitely have no control over whether the patient is invested in coming to see me, regardless of how sick I think they are.

But that doesn't mean the blow is any softer when a patient has a bad outcome due to a lack of access to resources, regardless of the cause.

I used to be more involved in health policy advocacy than I am now, and I always felt the motivation to do that work stemmed from the need to fix problems that I saw first-hand. Not only is it effective to tell my legislators a story about insulin prices and the Medicare doughnut hole -- making them more informed voters and bill writers -- but selfishly, it gives me a sense of action. I can tell the patient the next time I see them that I took their story to D.C., or to CMS during a comment period or a hearing. I don't feel I'm failing patients if I'm actively advocating for change that benefits them.

Unfortunately, I reached a point where I didn't have time to do as much advocacy work, and I also sometimes felt like although high-level health care reform needs to happen, the situation isn't going to be different tomorrow. Meanwhile, I'm left staring at a patient with diabetes who needs insulin right now but can't afford it.

What has shocked me over and over again is that even other health care providers sometimes are surprised when I tell stories about patients without medicine. Yes, I work in an office with a 340B pharmacy, but guess what? That doesn't make medicine free. It makes it more affordable if you don't have insurance. But I am not exaggerating when I say that there are patients who have zero dollars for medicine.

So recently I've shifted my efforts to work on small-scale solutions. I haven't abandoned the big-picture changes that need to happen, but I also felt I needed to rethink what it takes to make an impact in my own community. I can't get Medicare-for-all approved by Congress on my own, but if I can help a patient with financial struggles get an antibiotic prescription filled so they don't die from pneumonia, then I've done my duty. It's not enough to diagnose someone with pneumonia, prescribe the correct treatment and send them to the pharmacy; if they can't afford the treatment, then I've accomplished nothing.

Although many would argue that our responsibility ends at treatment decision (because legally it does), just as many of us aren't willing to stop at the exam room door in caring for our patients.

Any teacher, supervisor or boss I've ever had will tell you that I tend to aim high. I apply for leadership positions no one else thinks I will get. I ask people to do things that might be impossible. And sometimes I win.

Even in high school, I can remember being told by a vice principal that I couldn't have the schedule I created because it was all science classes, and that it was too hard. I did it anyway.

I'm not saying I always succeed, but I definitely am not shy and don't miss an opportunity.

One day I was picking my son up from school and ran into a friend who mentioned an organization offering health care grants. She suggested that I should get in touch with them if I had any ideas.

Oh, I had ideas.

Since getting our community health worker program up and running, my office's fitness center enrollment and usage increased. So significantly, in fact, that the equipment broke due to overuse. We don’t charge patients to use the fitness center, so we didn't have a revenue stream to repair or replace equipment that originally came via a grant years ago.

I met with representatives from the Greater Kanawha Valley Foundation(tgkvf.org) to show them our facility. During the course of the meeting, I told stories about my patients and how heartbreaking it was when we started doing social determinants of health screenings. Not only were we uncovering food and housing insecurities, we were asking questions that we didn't have a means to address.

I ended up applying for grant funding not only to make our fitness center functional again, but also to help address some of the social determinants of health indicators, specifically electricity and medication costs.

As I said before, it isn't enough to prescribe the treatment if the patient can't utilize it. Oxygen, nebulizer machines and insulin all require electricity. I have resourceful patients who find ways around this by storing all but a few doses of insulin at someone else's house or running extension cords for insanely long distances from a neighbor to power an oxygen concentrator. But I have others who literally go without. Despite what most people think, there are not enough programs to help everyone. And those without will live shorter lives because they lack what most of us take for granted as basic necessities.

We are just starting to use our grant money. This week, the treadmills are supposed to arrive for our fitness center. We were able to get someone's electricity turned on, and we have helped pay for quite a few medications that patients were just going to go home without.

These interventions only affect one person, or family, at a time, and the resources will run out once we spend the $15,000 allotted for medication and electricity bills. But each day that we are able to provide someone with a blood thinner they were going to skip for a month, or provide a family with a place to exercise -- a place that also has heat, water, a shower, etc. -- I feel like I've done far more than any trip to Washington could accomplish.

This all was possible because of a local philanthropic organization that serves six counties in West Virginia. So, my advice to those out there feeling like they don't have a free second to stick their head up above their laptop screen: You might just find what you and your patients need if you look around. And never hesitate to ask -- for anything -- because someone might just tell you yes.

Kimberly Becher, M.D., practices at a rural federally qualified health center in Clay County, W.Va. You can follow her on Twitter @BecherKimberly.(twitter.com)

Posted at 10:03AM Jan 29, 2019 by Kimberly Becher, M.D.

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