Bringing a ‘Whole-hog’ Approach to Prevention, Public Health

As an undergraduate at the University of Puget Sound, Decker wanted to lead his outdoor club on backpacking trips. That led him to take a wilderness first responder course, which meant facing the elements — and actors feigning gruesome mishaps — in long days outdoors in Tacoma, Wash.

“It was really fun,” he said. “That is still my favorite medical education course I’ve ever done. It was so creative. I started from not knowing anything to being able to do a cricothyrotomy in 10 days.”

A few years later, Decker had an opportunity to take another wilderness medicine course as a resident at Cascades East Family Medicine Residency and eagerly signed up. He found the trip stimulating, educational and fun, but something was missing.

“There was no fake blood, ridiculous scenarios or manufactured opportunities to overact in the name of attempted realism,” he said.

Decker asked if he could make changes for the event the following year.

“I went whole hog,” he said.

Or, perhaps more accurately, whole deer.

Decker acquired deer bones from a local butcher so he could create the illusion of open fractures, brought along Halloween makeup and, of course, fake blood. He also introduced “surprise scenarios,” including his own staged fall from atop a bus.

“It took a while for people to realize it wasn’t real,” he said, “but you have to practice doing things with your adrenaline pumping. How do you apply a pressure bandage or put a tourniquet on? Did you remember to bring your first aid kit, and do you know what’s in it and where everything is?”

Decker, a fellow of the Wilderness Medical Society, now teaches two wilderness courses a year to Cascades East residents as well as physicians from across the United States and even Canada.

“It’s a great way to spend a week,” he said.

He brings the same passion to everything else he does, and his to-do list is lengthy.

Decker, who will complete his master’s degree in public health in December, knew he wanted to work in both family medicine and public health when he finished residency. He said he stayed in Klamath Falls, Ore., because Sky Lakes Medical Center sees the value in investing in public health. His employer has built a wellness center, complete with a four-stove test kitchen, and he is the center’s interim medical director. Part of his time is dedicated to public health work, which thus far has included setting up video visits, maximizing the EHR system and participating in countless city council meetings. He helps with the medical center’s community health worker program, and he is re-launching group visits for patients with chronic conditions that had paused for COVID-19. He also is faculty at Cascades East. He has served continuously on the Oregon AFP Board of Directors since becoming a resident representative in 2017 and is now the chapter’s president.

“It’s just doing what I love,” he said. “It’s hard and expensive for people to be healthy. That’s a shame, and I want to change that, whether that’s shifting social norms or changing policy. We need to make gaining and maintaining health easier, simpler and cheaper.”

Working hard and multi-tasking is nothing new. After graduating from the University of Puget Sound, Decker took a year off from studies before heading to medical school because he “wanted to know what real life was like.” He worked 90 hours a week, splitting time between Health Care for the Homeless, a camping supply store and working 14-hour shifts as an emergency medical technician.

Decker had volunteered at Health Care for the Homeless as an undergraduate, and a social worker taught him to do her duties there. That created an opportunity when she resigned.

“I had no idea it was a plan of hers,” said Decker, who spent a year as a case manager, helping people gain access to housing, counseling and medical care. “I didn’t know she was training me. That experience was impactful because it made me realize how much the systems in our society at large affect people’s overall well-being. It was really eye opening how much of the health care system is really just a sick care system.”

The experience cemented Decker’s interests in public health, prevention and policy. As a student at the University of Minnesota Medical School, he served on his state chapter’s legislative committee, which commissioned a study on the feasibility and cost effectiveness of a state-based single payer health care system for Minnesota.

“I want to prevent illness, not just fix it,” he said. “I really want to affect populations at large, not just individuals. I love working with individuals, but I also love the idea of making change at a community-wide level.”

Decker, for example, worked with a group of stakeholders who successfully lobbied Klamath Falls’ city council and its parks department to expand the area’s bike trails, protected bike lanes and mountain bike trails. He also helped convince his health system to implement an incentive program for employees who walk, run or bike to work.

“You can impact so many more people from a policy perspective than you can as an individual physician,” Decker said. “I can see 20 patients a day, but there are 23,000 people in Klamath Falls. In one night at a city council meeting, if we can convince the city to put in a bike lane or new park then all of a sudden we’ve affected thousands of people, and not just for the one hour they’re in my office but for the whole time they live in Klamath.”

Decker, who considers Oregon state senator and family physician Elizabeth Steiner Hayward, M.D., an inspiration, quipped that his ideal job would be as a half-time clinician and half-time state governor. Alas, the requisite exposure of a public servant has stymied that desire.

“There’s too much contention and division currently, so I won’t be running for governor,” he said,” but I would happily take a position as a public health advocate.”