With a Little Help from My Friends
What will the future of health care in Western New York look like?
In the following four stories, an interwoven cast of patients and health care providers - Barry Glover, Miranda Trimble, Don Castle, Laura Castle Clark, Felicia Johnson, Tony Tomasello and Anita Wallace - interact with each other on a single day in 2018, Friday, June 22, to be exact. The date is the same in each story but each Friday has been reached along a different path, with distinctly different outcomes for all involved.
The recession of 2009 made cutting health care costs a priority for the 2010 Congress:
- The ER was now reserved for the most serious emergencies.
- Entrepreneurial medical associations, as well as religious and community-based groups, set up 24-hour clinics where physician's assistants and nurse practitioners handled most fevers, stitches, and broken bones.
- Simpler diagnostic practices there meant a decline in more comprehensive medical testing elsewhere.
- Companies that still offered insurance began to rely upon prevention, giving incentives for healthy lifestyles.
"Perfect," Tony Tomasello said, depositing the spent insulin syringe in a pink biomedical waste container. "Do it just like that every day and you'll be fine."
"Thanks, doc. You know, I was ticked off my boss made me come here." Barry Glover was a middle-aged man beginning to soften in the middle. "Then I got stuck with the bill." Newly diagnosed with Type 2 diabetes, he had come into the East Side Clinic and used his debit card to learn how to inject himself and manage his disease. "But I'm glad I did. They ought to put you in charge of this place."
"I'm a physician's assistant," Tony said. "I prefer patient care to paper work. Now, we covered these information pamphlets, and you know a healthy diet and regular exercise are just as important as your daily injection. If you think the needle will take care of everything, it's easy to slack off."
"My wife won't let me," Glover said. "After my first appointment with you, she got books on the right kinds of food, and she's going to sign us both up for a gym. This clinic of yours is a lifesaver."
"It's a good place to work," Tony said. "Two doctors, three physician's assistants, three nurses, a social worker - we do a lot for this side of town, which doesn't have a lot of doctors."
"So who is in charge? I'll put in a good word for you."
"The director's name is Dr. Wallace." Then Tony fingered the manila envelope that held Glover's medical records, diet and exercise instructions, and enough diabetes information to choke a herd of elephants. "These are your new marching orders," he said, handing the envelope to Glover.
"That's a lot to read, doc."
"I know," Tony said. "But this is your last appointment and not following these instructions could cost you a lot more than you want to pay, physically and financially." He bit his lip. "Look, I bet your church has a parish nurse who could help." "Yeah, doc," Glover said. "But she won't be as good as you."
Tony's last patient of the afternoon was Felicia Johnson, a suburban mother with chronic lower back pain. She had come to their clinic some weeks earlier, already having reached her annual insurance limits for treatment of such a condition. She'd had physical therapy for the approved number of sessions and prescription painkillers for the approved number of doses. Nothing had relieved her pain, but at this point any further treatment attempts would have to come from her own pocket. Though the clinic accepted payment from several health insurance providers, the bookkeepers were always happy to have clients who tried to ride plastic ponies named Visa and MasterCard off into the sunset. Banks paid on time and never questioned expenditures.
After referring Johnson for an MRI with the imaging service used by the clinic, which already had a three-month backlog, Tony shed his lab coat, closed his locker, and went to knock on Dr. Wallace's office door. He stepped inside when she said, "Come in," and stopped several feet from her desk.
"What is it, Tony?"
"It's about my mother, Dr. Wallace," he said tentatively. "Her dementia is getting worse. She's on Medicaid's waiting list but she'll hit critical need before a nursing home bed opens up around here. I tried to go through the church clinic near our house but the wait is too long. Right now, Medicaid's paying for adult day care and a visiting nurse, but I do everything for her in the evening and through the night. When she goes in, I've got to sell her house and turn everything over to Medicaid - and since I'm living there too..." He spread his hands in a gesture of surrender.
"How can I help?"
"I was hoping maybe you could write a referral that expedited things through mental health channels instead of elder care."
"I'd be happy to try," Dr. Wallace said. "But getting her into the mental health stream won't be easy in this climate. I'll need to examine her first, though, so bring her in tomorrow."
"Tomorrow's Saturday," he said. "One of our big walk-in days."
"We'll make room," Dr. Wallace said. "She's your mother, Tony. That makes her family." And she smiled.
Tony said softly, "Thank you." Then, for an instant, his throat caught, and as he turned to go he glanced once more at his boss, who had already returned her attention to the stack of papers on her desk.