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“ANOTHER VIEWPOINT ON PRIMARY CARE”

Dear Editor,

 

I want to make it clear that the viewpoint I provide here is my own, and is not meant to imply that I am speaking on behalf of the LBJ Tropical Medical Center, where I am employed, or the American Samoa Community Health Centers Governing Board, which I currently chair. 

 

I am very sad to hear the news that the former Primary Care Clinic is now just another Medical Clinic and ER backup. I feel that this action is taken as an expedient means to reduce the work load of the ER and Medical Clinic physicians at LBJ, rather than any attempt to improve patient satisfaction, disease management, or patient outcomes.

 

The comments attributed to “one female physician” that “while we see close to a 100 patients at the ER on a daily basis, those with the Primary Care see roughly about 20. It’s not right or fair.”

 

Is this what doctors are most worried about — whether the way health care is delivered is “fair” to them? What about the patient and his/her needs? Is health care in this Territory delivered under the cowboy mentality of “herd em in, herd em out? Are we more concerned about through-put than outcomes?

 

I am certainly sympathetic to the long-standing problems the hospital medical staff face, and the burden placed on them by chronic staff shortages. But the solution is not to dismantle the one shining example of how primary care should be delivered in this Territory, as an expedient means to relieve staff shortages. Once again, the “tyranny of the urgent” health care model wins out over population health, when unenlightened, shortsighted decisions are made without consideration of their long-term impact.

 

I hope the legacy of the former Primary Care Clinic will live on through a transformed practice model in the community clinics of the American Samoa Community Health Centers. This is the model currently advocated and promoted nationwide as part of the effort to reform an antiquated and inefficient U.S. health care system, and it should be a model advocated and promoted in this Territory. 

 

Charles (Mick) McCuddin

 

(Editor’s Note: What everyone seems to miss is that the Primary Care Clinic’s former main doctor, who has since resigned, was noted as one of the most highly paid doctors at LBJ, and the move was seen as a ‘cost saving’ issue — as per a comment from the faipule board member.

 

The subsequent actions of the CMO to merge the clinic into the medical department can also be pointed to as a revenue generating move, as followup patients now have to go to ER ($15 or $20) to get an appointment to go to the Medical Clinic (another $15 or $20) — that’s $30 or $40 to be seen, vs $15 or $20. And since walk-in patients are also encouraged, that’s an additional $20 a head or body the clinic would generate.

 

So, yes, “herd em in, herd em out” seems to be the LBJ care model for these clinics.

 

And one can only wonder, if the community clinics become the mainstay of medical treatment in American Samoa, what the financial consequences to patients who are hospitalized at the LBJ will be? Or patients that have no choice but to get their medication from the only certified pharmacy on island? And what about the lab tests?

 

After all, how else will LBJ then pay for its management & staff? ra)