You might be surprised, but this is the first time in my career that I’ve been able to say that. In general, emergency medicine is a thankless job. Emergency physicians take care of people, who often don’t take care of themselves, who are subject to many social ills (drug abuse, violence, substandard living conditions, inadequate access to basic healthcare needs, etc.), and we do so typically during a crisis in their life.
I have worked in emergency departments in the inner-city, the suburbs and rural environments. My experiences, I’m embarrassed to say, made me a cynical physician who thought everyone had an ulterior motive, and I found few redeeming qualities in people. Thankfully, my job in Telluride has renewed my faith in the inherent goodness of people and revived my love of medicine and all that it can accomplish. My colleagues from medical school and residency think I have the “dream job.”
Of course, that’s not the end of the story. While my job is great, it is not without problems. I work with intelligent and talented physicians and nurses in the emergency department. My patients are eager to participate in their healthcare decisions. My biggest constraint is the physical space in which I work. I treat patients with essentially no privacy. Three of my exam rooms are in one room separated by curtains. It is disappointing to be unable to provide my patients with the confidentiality and privacy they deserve. Additionally, sometimes I am reduced to treating patients in the hallway. I never thought I would find myself sewing up a patient while he rested his injured hand on a box that the UPS man delivered that morning. If you’ve never had the misfortune to experience this, I hope the story communicates why we need a new medical center.
There has been much discussion recently about the details of our new medical center. I am proud to say that I have participated in the planning process. I feel it has been done responsibly (both fiscally and environmentally) and comprehensively. Kim Hewson, MD, recently wrote a column questioning the Hospital District Board’s proposal. Dr. Hewson is an accomplished and well-spoken colleague, who I am happy to know, but I must respectfully disagree with much of his article. Telluride has long been an expensive place to live. Locals have made a conscious choice to exist here. We reap the benefits of that choice with highly ranked schools, an award winning library, a beautiful ice rink, and other amenities. I don’t see the medical center bond as an expense, but an investment in our future.
It’s trendy to support a new emergency department, but it’s primary care that is the basis for healthcare. Primary care provides preventative care, makes sure that children are immunized and makes sure that chronic health problems are addressed before they become life-altering conditions. There has been a community health clinic in every town I’ve worked. To be honest, they were never ideal. They were structured with adequate healthcare providers who were saddled with too many patients and a “too-small” budget.
This is not the case in Telluride. We have a self-sufficient primary care clinic that treats all-comers regardless of their ability to pay. The primary care clinic is staffed by highly-educated, intelligent, caring practitioners, and for that this community should be thankful.
Working together with the primary care physicians translates into more efficient and higher quality of care for our patients. Just this past week, the primary care staff was quick to lend a hand when I had two critical patients at the same time. Not only did they draw blood and run labs, they took care of the patients waiting for the emergency room so that they didn’t have to wait a long time while I was tending to the more critical patients. They also provide rapid follow up care for our patients. This is vastly important and without it, more patients would require hospitalization.
I view just building a new emergency department without primary care as a step backward. Our community needs and deserves the safety net clinic so that all citizens can receive healthcare.
Our proposal, which is by no means impractical or extravagant, shows a positive cash flow business plan. We need a new medical center and we can afford it. Now the decision is left up to the voters.