Tag Archives: civil rights

two stem cell and bone marrow registration drive possibilities: please share

Please share these dates:  6/28 and 7/12 when folks 18-44 can register to register to be stem cell or bone marrow donors if a match is found.  The registry needs you!

Those 45-60 can register on line. Please check out information on bethematch.org regarding what this means!  The registry needs you. A cheek swab and a willingness…

Here is the thing: 97% of whites find a partial match.  65% of African Americans do. Other ethnic groups are lower than Whites and barely higher than those of African descent.  For a full match: 75% whites and only 25-35% of those of African descent.  Others are in between. Diversity in the registry is key. The sites for the drive are because they are diverse, inclusive, and social justice minded.  Please come by.

Feel free to share the fliers

Thanks! Sharon

Matt Dobie Immaculate

Matt Dobie St T

Mt. Zion and Civil Rights

As promised when posting Barbara Thomas’ remarks, here is a very brief primer on Mt. Zion Baptist Church and involvement in Seattle Civil Rights history.

Mt. Zion Baptist Church was founded in 1894 with 8 founding members who met in a building on the University of Washington campus. In its early years it moved several times and had a number of pastors. Buying property at 19th and E. Madison in 1918, it remains there today.

Between 1920 and 1957, there were only 5 pastors and several were active in the community as voices for civil rights.

  • Reverend F.W. Pennick (1940-1942) was a civil rights activist
  • Reverend F.B. Davis (1942-1954) ran for Seattle City Council in 1946. There were only 3500 registered African American voters in the city but he got 27,000 votes.
  • 1948-1958 brought Reverend Samuel Berry McKinney to Mt. Zion.
    • 1961–McKinney hosted Dr. Martin Luther King at Mt. Zion. This was King’s only visit to Seattle.
    • 1963–McKinney led a march of 400 to promote and end to Seattle’s housing segregation.
    • 1966—500 children attended a Freedom School at Mt Zion during the Seattle schools boycott. This Freedom School was one of 7 churches and 2 YMCAs participating, for two days (3/31 and 4/1) when about 4000 children boycotted the public schools, protesting the segregation of the schools and the quality of the education.

Throughout the years Reverend McKinney and Mt. Zion have maintained their activist activities. And for many years we could watch Reverend McKinney, along with Patronella Wright and the Total Experience Gospel Choir perform Langston Hughes Black Nativity at the Intiman.

For more information:

Blackpast.org. http://www.blackpast.org/aaw/mount-zion-baptist-church-seattle-washington-1890

Seattle School Boycott of 1966. http://en.wikipedia.org/wiki/Seattle_school_boycott_of_1966

The Reverand Dr. Martin Luther King Jr. Day Key Note at Mt. Zion Baptist Church, Seattle

I am pleased to post this guest blog by Barbara Thomas, who I am lucky to know because about 22 years ago we started to work together as doctor and patient. Barbara is a brilliant and creative artist, writer, and so much more.  A view of what she creates and shares is on her web site here. This year, on January 16, 2015, she was the keynote speaker at the Reverand Dr. Martin Luther King Jr. Day celebration at Mt. Zion Baptist Church in Seattle. It is important to note that Mt. Zion has played an important role in the Seattle civil rights movement since at least 1940 (more about that in another post).  For today, here is Barbara’s speech.

          Dream and the Dream Catcher–MLK Day—Barbara Earl Thomas –

January 16, 2015

I am humbled and amazed to be here today to speak in honor of the day and on the occasion when we all pause for a moment to consider what this day means to us and our nation. I thank first Jill Wakefield, Chancellor of the Seattle Colleges for the invitation, Earnest Phillips, Seattle Colleges Executive Director of Marketing and Communications for the great support and Senior Pastor Aaron Williams for continuing the grand tradition of having this address at the Mount Zion Baptist Church.

I am additionally honored to stand at the podium in Mount Zion Baptist Church, led so long by our very own Samuel B. McKinney, who in 1961 arranged and hosted the one and only visit to Seattle that Dr. King would ever make. They stood together two human beings—with all the other human beings stated their case, shaped the vision that has sustained us all of these years. Just imagine: the humanness of their being—mere mortals (like you and me) facing that Mount Olympus-sized dream.

In 1963, Dr. Martin Luther King, Jr. expressed a dream so eloquently that we are often left speechless in its wake.   When he told us that, “This sweltering summer of the Negro’s legitimate discontent will not pass until there is an invigorating autumn of freedom and equality—1963 is not an end but a beginning,” that is where I have to start every day. We stand, each one of us, as a link in the line from that place Dr. King called the beginning. On that day we were given a vision, hope and a star to reach, not knowing in that moment, in1963, all that would befall us as a people or nation. Even as we mourned the assassination of Medgar Evers we could not foresee the assassinations of John F. Kennedy nor take in the possibility that Dr. King would himself be mowed down, his death, killing hope in its wake.   We could not imagine the depths of Vietnam and all the wars that would bring us to September 11, 2001 when the world as we knew it stopped, stunned into the realization that it had come to this. If we didn’t know before, we know now we are in this spaceship together.

At the moment Dr. King delivered those now immortal words—“I may not get there with you,” he faced thousands of hopeful people who helped to make that particular moment possible. I do not diminish Dr. King when I say he (we) would not have gotten here without all of those who took up the seemingly small but crucial tasks. Today we must remember the John Lewises and Fredrick Reeses, the Ralph Abernathys, Ella Bakers and Bayard Ruskins who worked tirelessly off the podium, to the side, out of the spotlight. Dr. King was carrying their torch and he spoke for them. I pay homage to all of those who got on buses, on trains or in their cars to mark that moment. But I also remember the mothers and fathers who were unable to attend but kept the home fires burning, attended their children, kept the school doors open, worked their jobs, and guarded the voting booth or gave a hand to the less strong along the way.

When I think of the small steps, I start with my very own existence by way of my grandparents, Doc and Ethel Lee, and people like them, who came here in the early 1940s would eventually send for the daughters – in my case, Lula Mae who would become my mother and, her sister, Annie. They, like the grandparents and parents of so many, migrated here from Louisiana, Texas, and Arkansas and all parts south to start anew.  They came looking to work hard and find that American Dream. My father would arrive by way of the military, having completed the 9th grade and my mother the 11th. One might say why did she quit? She was so close, only a year away from graduation. Ah, that was a subtle custom, a brutal dream killer. If you were Black, in that place, the 11th grade was as high as you were allowed to go. She was stopped, sure enough, but she did not quit. She simply lifted her dream and moved it forward to her children. Little did I know that I was her/their dream-catcher. I held their dream, never knowing how full I was of their hope. I, and most of my classmates, could not in our young lives appreciate or imagine the gravity of what we represented to those people who sent us out of the house everyday. We could not decipher the pride on their faces, the lilt in their voices as they spoke among themselves about us.

When we graduated it was not an individual accomplishment but a family triumph. Only years later would I understand and feel the magnitude of what now seems like such a small thing to hope for a child. I did not suffer the hardscrabble, sharecropping, cotton-picking life of my parents and grandparents. This was, by no means, luck on my part, but a well-laid plan, seeded by a grandfather’s courage when he struck out into the unknown. I did not experience the segregated south or Jim Crow trains but I understood, as many of you here do, that my small accomplishments were part of a larger hope passed onto me, not always in words, but through a look, a sigh, and the embodiment of their hard work.   It was my/our job to get the goods, grasp the knowledge, the word, and the secret of the system and bring it home and share it with whoever needed to know.

Today with the ubiquity of the Internet, Facebook, Instagrams and Tweets the big moments now come to us in an instant, cause a momentary explosion of comment, only to be replaced by another startling world event. The good news is it is ever more clear that we are bound together and responsible to each other. As we share the human spectacle no transgression is hidden for long. The bad news is that the repetition of the images can cheapen even the most fantastic human event. We stand stunned in the face of impending environmental disaster; global and local terrorism; the images and sounds of the suffering confront us. As they happen, we are dwarfed in the shadow of their enormity.

What can we in our smallness do? We who glean the fields today gather those shafts of wheat left behind. In grief from so much loss, this work may be our salvation.   Our job, in these days of “endless blogs” and “lives gone viral”, may be again to find the sacred in the mundane act of everyday living.   As ordinary as it sounds when we send our children off to school each day—we re-enact a sacred ritual for which people have risked beatings and death to achieve. It is an impulse rooted deep in our human make up to embark on this eighteen year commitment –where one day builds the week, month and years that culminates in the moment when all the small steps add up to one well-prepared life. As each educator stands in front of the classroom he or she will struggle with the inadequacies of the resources, but daunted as that teacher is he/she finds a way to connect with the student who is somebody’s child and the future of us all.   When we resonate, as we must, during brief flashes of clarity, we grasp that each and every one of us matters, because without the work, hope, love and dedication of the many, that moment in 1963 would never have happened.   Who knows, if we will in our life times, have that kind of moment again? But I say, maybe this is the time not of the one, but of the many.

I am grateful to those of you who have raised your families when you might rather have been doing something else; those of you who helped a young person who was not your own child; given money and time for the betterment of your community even when you got little or no notice—you may not be thanked but you will do it regardless. I want to thank those of you who have gone into teaching when it was clear that it was no place to make a fortune, but it remains one of the most important professions for any community who knows what is truly at stake.   Our next big challenge as a community and nation will be to reclaim higher education as an affordable right for the many, not a luxury for the few. We have to take it back from those lending institutions that would bankrupt our families and children, mortgage their futures.

My first venture into college was at what was then called Seattle Community College—as an evening student, where I took my very first English class. My mother and her best friend Viola who was also my hairdresser, dropped me off on Summit Avenue Annex at 6pm and picked me up at 9pm. I don’t know what those two young ladies did when they left. I know they didn’t sit outside and wait for me for 3 hours–but I never asked. It never occurred to me that they wouldn’t be there.

Today I ask you to remember the aspiration, the small steps needed to arrive. It’s not okay to say that because we can’t do the monumental that our individual contributions don’t matter. Who are we to say that our “one” vote means nothing? Who are we to overlook the life of even one child lost in violence or despair? In these days when we are overwhelmed by the wave of the Michael Browns, Trayvon Martins or the child who kills himself or another, none of it is okay and I say that every small thing matters.

In this light, Dr. King’s speech is a love letter sent to a future that he would not see. And, it is a message, for all of humanity. In 2015 when the gravity of poverty yet exists— and societal injustice brings no relief from the violence we heap upon each other—we wonder if we have moved the needle of progress at all. When in doubt, take the harvest from your fruit trees to the food bank—volunteer at your local school whether you have children or not.

When my grandfather decided in the 1940s to move his family from rural Shreveport, Louisiana to Seattle, it was no small move. These former sharecroppers and cotton pickers were the sons and daughter of those who passed on a direct memory of slavery. They were the many un-graduated from any high school with no diplomas offering up hands in labor and arms in defense of the only country they knew.

Today let us remember the individual stories, the small kindnesses of he who opens the door, holds the train, shares the food, the knowledge, the kind word— In 2015, I am charged with remembering the gifts of all those who came before me. These individuals were part of the raw stuff of the dream to which Martin Luther King, Jr. would refer. As I stand in Mount Zion Baptist Church, I must speak of Reverend Samuel B. McKinney, who in 1961, met with Martin Luther King Jr. right here in Seattle. He, himself a 1949 graduate of Morehouse College, was exemplary to all in his parish of the value of education, the power of voice matched with reason. As the church was one of the pivotal symbols of unity in Seattle’s Central District, the core of the African American community and continues to be that for many. We were neighbors who held a tightly knit community together and the businesses that served them and us. In 2015 we lament many of the changes but we also take heart and are charged with naming the successes of those who have caught the dream and moved it forward. We still stand for uplifting the race, community and the country. My grandfather used to say “If you live long enough you gonna see some of everything.”

Many of us have lived long enough to remember Sam Smith, the first Black City Councilman; the election of Norman B. Rice as our the first Black Mayor of Seattle; Ron Sims first King County executive; Larry Gossett, County Council; Dr. Charles Mitchell a Seattle Colleges Chancellor; Judge Charles Z Smith and Charles Johnson and Richard Jones all exemplary leaders; and Dr. Ben Danielson at Odessa Brown; Charles Johnson, author, National Book award winner and MacArthur Genius; Octavia Butler, award-winning science fiction writer; and August Wilson, Pulitzer Prize-winning playwright spring from our culture to live among us to tell their and our stories. And, yes there is Barack Obama, the first Black president of the United States of America.

I pray, let me never be so overwhelmed or habituated to the grand gesture that miracles such as these no longer impress me. I say we are here today to engage in the “mindfulness” that recognizes these are still events for which we should and can be grateful every day. There is a place for, and merit in being the second, even third or fourth–Mayor, City or County Council person, community leader and National Book Award winner, scientist and doctor. These achievements remind us that there was a time, not so long ago, before that first, when we never thought we would live to see the day. Our job now is not just to pass the dream on, but to take it out, brush off the tarnish of any personal disappointments and pass it on as we ourselves receive it, in all its fresh wonderment. Today let’s remember to re-appreciate and re-engage and be amazed. This may not be the moment for the one—but it just might be the time for the many.

Women Authoring Change

my 2012 abode

my 2012 abode

In the past I wrote about Hedgebrook. (radical hospitality) And I shared about the women who were there when I was. women writers  And their cook book (here) is amazing, reminding me of the weight I gained during my residency in 2012. Well now it is time for YOU to apply for a residency.  Check it out here!  If granted, it is like nothing you will have ever had given to you.  One constellation of six who were there when I was are pictured below, representing several nations, multiple genres, and huge heart. Also, throughout the year, they have master’s classes as well.  For a weekend or longer, you will have your own little cottage, 5 other writers, solitude, amazing surroundings, and a master teacher. https://sharondobiedotcom1.files.wordpress.com/2013/11/post-debate.jpg An 2011 article in the Guardian   showed that in Britain and the US, male authors are reviewed 3 times more often than women. And guess what?  Who do you think the reviewers are?  Yes, similar proportions for reviewers: men: women 3:1. VIDA does an annual evaluation.  In 2013 the NY Times and The Paris Review made big progress, but check out the tables.  We still have a long way to go to have women’s voices heard in print. (VIDA) Hedgebrook supports women writers.  In particular it wants to support women authoring change.  My three weeks there in 2012 were life altering thanks to the vision of the place, the belief in the work I was/am doing, the amazing nurturing of the staff and the place, the women who were there with me, and the space to be there. Please do check it out:  Go there for a master’s class.  Apply for a residency.  Support them.  Go to their events.

Josephine Ensign wrote about Elizabeth Austen, her poetry and the event where she read. (see blogs I follow)  Elizabeth is the Washington State Poet in Residence, truly gifted and a Hedgebrook Alum. Check out her blog and her work here. Go to one of her events.

Support women authors! Our voices matter. In the farmhouse at Hedgebrook, where we gather for dinner with our amazing chefs, there is a living room with floor to ceiling and wall to wall (except for the fireplace) bookshelves, all full.  Every book in the shelves is by or includes a Hedgebrook alum.  Let us work together to publish so much that we must support Hedgebrook building a new building or modifying some of their other buildings to house all the works of the women who pass through there.

Not a single story

So many layers.

It always amazes me how we bring many lenses to any situation and these are how we see the world. Some, well maybe most of us, have several lenses, or maybe should.  What do you think?  Which lens rises to the top depends on so many things.

In the story of today, shall we look at this through the just get the person to safety lens?  How about the really weird, as in I can hardly believe I felt this and though it cannot be close, here I am, standing in another’s shoes lens?  Or the health-care system, it really can be better lens?

Or all of the above.  They all fit for me. I like the notion of multiple views.

The story:

It was a busy week back at the ranch, er job: several evening events, a night on call, but no matter.  I had made plans to take Friday off and even arranged coverage for Monday; we were going to the snow, heading for Canada.  “We” would be my neighbors and me.  They drive, I have the housing arranged: me in one room, their daughters in the other, the parents in the living room.  A close friend’s daughter with a season pass wanted to come too and she could sleep in my room.  All set.

Then my friend, mom of the kid who would be my room mate, decided to rent a place in the same building and come as well with another friend of ours.  All good….except she was tired and it was a long week and she was ambivalent.  Her daughter and I both talked with her, and in the end she decided to come.

Thursday evening we all (including my friend’s husband) were at a fund raising dinner, and all seemed ready for the next day.  I arose Friday, packed, and my neighbors and I hit the road.  Many hours later my friend, her daughter, and our other friend arrived.  My friend did not feel well, was nauseated and had abdominal pain all day.  She had not eaten since the night before.

Saturday morning it seemed clear that my friend needed to be seen at the clinic.  She, our mutual friend, and I (all family medicine doctors) feared appendicitis. While my neighbors, my friend’s daughter, and I went to ski, the other two went to the clinic.  By lunch, we knew. Her daughter and I headed down the mountain:  appendicitis.

We were in a location with no hospital.  We knew the ones along the way from there to Seattle.  Her husband was not with us because he had been on call, but had gotten sleep and was able to drive to the border and meet us. We knew there were surgeons in Squamish, then Vancouver, then Bellingham, then Everett, hoping to get her to Seattle.

The punch line is that she did get to Seattle, had her surgery around midnight Saturday night, and was home Sunday evening.

But that in not the point of this post.

I mentioned three lenses above.

Get her to safety: Who should go, where to go, who helped us know?  We had many possibilities.  Who should go?  Should her daughter drive her to Seattle?  What if she got sicker along the route and a doctor was not with her?  How luxurious that there were two other doctors along.  And who should go?

Stand in shoes:  The two doctor friends (Diane and me) decided to drive her to the border. Had we crossed the border, the wait to go north was close to two hours. We did not want her husband driving across. And she did not want us crossing to deliver her and face that wait. We opted to park at the Canadian border, talk to the guards, walk to the US border (about an 8 minute walk, in the pouring rain, our friend doubled over, us carrying her bags), talk to a US guard who by cell phone instructed her husband how to get to us without getting in the 90 min line, and delivered our friend to her husband.  Something hit all three of us, only shared after the fact. What we felt walking across, pouring rain, was a sense of vulnerability. It was a trek. 

Although we knew we had what we needed to get our friend across to the USA and us back into Canada, we were nervous and vulnerable.  How is it for others for whom the border cross has even higher stakes ?

We stood in line at the US station for pedestrians.  There were border patrol folks milling around.  It looked like they were not attentive to the lines and were not doing work.  We stood there.  Our friend was getting more and more hunched over.  We were scared. How much time did she have until she ruptured that appendix?  Finally we asked for help. The guard heard us and did help and a few minutes later our friend was on her way south and we two others were trudging back to Canada.

What do others feel in that walk between borders?  Really, we all knew ours was only 8 min between the two borders in that nomad’s land and yet each of us silently felt that anxt: what if it does not go well?  We all have enough life experience to know that what we felt had to be, given the certainty of our getting across, just a tiny fraction of what many millions feel when crossing a border under duress.

And the health care system:  Our friend had lab results and CT scan that showed the appendicitis.  We had seen the monetary charges: they were half what they would be in the good old USA.  Yet people complain about single payor.  Really? 

OK, once we handed her over to her husband, they were in the good ol USA.  One hospital/ surgeon on call would require she go to the ER.  Even if they accepted the CT scan and labs, there is that charge on top. (and by the way, there would be the delay and risk of rupture) A second hospital/surgeon would admit her straight to a room and then the OR.  Guess which was chosen? Surgery that night, home the next day.

Patients or money first?

What do you see in this story

What?

During the last years of my dad’s life, we all knew his hearing was not great.  I’m not sure why he did not get hearing aids.  We knew that large noisy groups made it hard for him to socialize and that he shied away from those.  He could hear us in small groups or one on one conversation, mostly.  I don’t remember feeling annoyed with him or him getting short with us when he could not hear. He was career navy and served in WWII, Korea, and Viet Nam so I know he had noise exposure as one culprit in his hearing loss.  And there was age.

I do remember feeling I wish we did not have to plan events so that he could be comfortable.

This brings up the question of who is responsible for what when there is a change in physical ability?  How much of the burden is on the person whose health and ability status changes? What about those in that person’s life?

Next week I will have molds made for hearing aids.  Some of my hearing loss is just family and age, I am sure.  I also sing in a group and in a concert two years ago, the tenors to my left were magnificently loud in several pieces and I heard immediately the tell tale ringing that did not stop when I left the concert and for days later.  Actually I still have the tinnitus, more in my left than right ear.  Luckily for me it does not drive me batty, either because I am already batty or because I just have enough going on that it is not on the radar of my life.  But I knew after that event my left ear in particular was in deep trouble for hearing.

I say “what?” a lot.  I struggle in my groups with students if the quiet students do not speak up.  My kids are frustrated at having to repeat themselves.  Maybe my students are too.  My friends tease me.  I say “wait til you have these shoes on…see how it is.” I laugh with them because I am good at laughing at myself.  Some people seem irritated when I ask for them to repeat themselves.  I feel “less than” even though I did not make this happen other than to sing next to loud people.

Soon after that concert a very close friend and I were at her family’s cabin.  I was saying “what?” a lot.  And she would then yell her next response, well not yell loudly, but much louder than it needed to be.  I got irritated and suggested that if she did not mumble I could hear her, that it was articulation not loudness that was the issue.  She retorted that I was going deaf and she did not mumble.  I told her I had an audiology appointment already made and that I still believed she mumbled.  Within the week I found out the degree of my hearing loss and mutual friends acknowledged that she does “mumble” a bit.

Loud places are hard.  It turns out that with sensorineural hearing loss, part of what happens is not only can a person hear less well, they also have a shift in the noise comfort level.  A normal hearing person will say “it is bothering me” when the noise level is at a certain decibel level.  A sensorineural hearing loss person will say it is bothering them at a much lower decibel level.  And that is independent of what they can hear in language at a given level.  I have had three hearing tests.  The first two my results demonstrated this.  In the third I “cheated,” because I knew of this concept.  I weathered the noise far beyond what was really tolerable…and I passed.  Yay me!  Not.

It turns out that a lot of our communication is not from hearing.  It can be body language, lip reading that we don’t know we are doing, etc.  The context helps.  Some people are better at accommodating, figuring out context and filling in the blanks.

And in some settings it is hard to ask people to speak up, or say it again.  I can understand why my dad and others with hearing loss tend to withdraw.  I have wondered if I should stop my working in the work I do.  Is that wondering because I question my skill or because I am embarrassed or because I am just tired advocating for myself?  I honestly don’t know. I just feel like it is hard, my problem, and well…I guess I just don’t know what should/could be a reasonable expectation in differnt relationships.  Many have trouble hearing our department chairman.  Is that my problem and should I just pretend I hear and be quiet?

Last week I felt like a sitcom.  My younger son yelled down to me from upstairs. “Mom, can you get me some paper?”  I yelled back, “what do you need paper for?”
“Mom can you just get me some paper, now?” I answered, “Nick, just get it from the printer, which is right up there with you. Won’t that work?”  He then came down stairs looking crosseyed.  “What is wrong with you?”  “What do you mean,” I retorted.  “You want paper. There is tons upstairs.” “Mom, I said, will you do me a favor!?” We both collapsed in laughter to his words, “get that hearing aid.”

I found a website that talks honestly about what others can do.  I know what I need to do.  Of course I hope the aids help.  The ones I tried before did nothing.

Here are tips if you are a normally hearing person with someone in your life who is hearing impaired from the Hearing Loss Association of America:

Tips for Hearing Person to Communicate with Person who has a Hearing Loss

Set Your Stage

  • Face person directly.
  • Spotlight your face (no backlighting).
  • Avoid noisy backgrounds.
  • Get attention first.
  • Ask how you can facilitate communication.
  • When audio and acoustics are poor, emphasize the visual.

Get the Point Across

  • Don’t shout.
  • Speak clearly, at moderate pace, not over-emphasizing words.
  • Don’t hide your mouth, chew food, gum, or smoke while talking.
  • Re-phrase if you are not understood.
  • Use facial expressions, gestures.
  • Give clues when changing subjects or say “new subject.”

Establish Empathy with Your Audience

  • Be patient if response seems slow.
  • Talk to a hard of hearing person, not about him or her to another person.
  • Show respect to help build confidence and have a constructive conversation.
  • Maintain a sense of humor, stay positive and relax
Tips for the Person with Hearing Loss to Communicate with Hearing People

Set Your Stage

  • Tell others how best to talk to you.
  • Pick your best spot (light, quiet area, close to speaker).
  • Anticipate difficult situations, plan how to minimize them.Do Your Part
  • Pay attention.
  • Concentrate on speaker.
  • Look for visual clues.
  • Ask for written cues if needed.
  • Don’t interrupt. Let conversation flow to fill in the blanks and gain more meaning.
  • Maintain a sense of humor, stay positive and relaxed.

Establish Empathy with Audience

  • React. Let the speaker know how well he or she is conveying the information.
  • Don’t bluff. Admit it when you don’t understand.
  • If too tired to concentrate, ask for discussion later.
  • Thank the speaker for trying

I return to the question.  Who has responsibility for what? What is your role?

The insanity of it all.

A team of four residents (maximum of two at a time in 12-15 hours shifts at the hospital) and an Attending/faculty doctor cares for our family medicine patients when they are hospitalized. Other services have other team structures. Our patients come from our clinic and a number of satellite clinics and are adult medicine patients, women in labor, new moms and their newborns, and some women with prenatal problems requiring hospitalization. The residents are first year (interns) and senior (second and third year).  Our residents are generally smart and attentive and work well with our patients, treating them as individuals with lives outside the hospital and with careful management of the reasons they are in the hospital.  They do a good job running between laboring and delivering women and our very ill internal medicine patients.

Recently when a friend was the attending on the service, a patient with complex medical and psychosocial concerns was admitted.  The team created the time and space to really unearth some of the underlying physical and social challenges faced by this patient.  This led to a carefully orchestrated discharge plan, including where and when she would be seen for ongoing care and what elements that care might contain.

Once again our health care system snatched defeat from the jaws of victory.  The patient’s insurance covered our hospital, but it turns out it did not cover being seen in our neighborhood clinic, which is part of the same health system.  The patient did not get the necessary outpatient care and was readmitted to the hospital.

Last night I heard that one of the major insurers in this area dropped a contract with a major hospital that is used by many physician groups.  Instead they are contracting with another hospital that has its own multispecialty group.  Now all the medical groups who have used the other hospital are rushing to see if the approved hospital will give them privileges to hospitalize their patients. If not, their patients will have to be hospitalized at the approved hospital by doctors who do not know them and whose electronic medical records do not communicate with those of the outpatient doctors from the other hospital.

What has always been clear to me:  the insurance companies will keep their profit margins.  (Oh yes—hospitals and doctors’ groups want to do the same.)  None of this is the recipe for improving health and health status or for curbing health care costs.

The task of trying to provide continuous seamless care for our patients just gets harder and more insane.

Every major country with good health outcomes has lower costs.  Take a look at the expenditure tables in this Commonwealth report.   Look also at : 1) the tables on mortality from index cancers, 2) hospitalizations, 3) deaths in hospital.  For all we spend, we do no better than other industrialized nations spending much less.  According to The State of the Worlds Mothers 2013 report, we are 30th in the world for newborn deaths on the first day of life. 30th!  The top ten with the lowest rates are Finland, Sweden, Norway, Iceland, Netherland, Denmark, Spain, Belgium, Germany, and Austrailia. Our spot, 30th, is worse than any industrialized nation.  Life span, you might ask?  We are 48th in the world, despite our spending.  Each of the industrialized nations with better outcomes than us also has significant government involvement in setting prices and policy, which our electorate continues to fight.

I am far less concerned with the troubles of the ACA website; gee, my electronic medical record crashes on me all the time when I am up late at night doing my charting.  I have to live with it, boot it up again, and still get the job done.  Even fewer choices of where to get care is ok with me.  That may be a price to pay to get more people covered, at least the way we have chosen to go about it in this country.  But if fewer choices and inadequate technology are accompanied by insane lack of coordination of care across locations AND by rising profits of insurance companies, well then, I continue to not understand how Americans can fear a single payer plan.