Archive for the ‘TBT Clinic’ Category

Advocacy For Improvement In Community Health

Friday, June 14th, 2013

By Don McCormick

There is a short story called The Lottery that is a metaphor for our local community health care system. In this story members of a small town assign death by stoning to a randomly chosen citizen. The game becomes accepted annual tradition in the town. Although the townspeople appear saddened at losing their family members and neighbors, they never question the morality of a game that gambles with human life.

Our community health system in which sales, profits, convenience, and productivity are placed above healthcare seems like this fictional short story. Patients and health professionals suffer under the system because they are powerless to change what is seen as the destructive health habits of individuals.

We know that improvements in our healthcare system stem from a broader understanding of the economic, social, and environmental factors that determine health. We can change the system by working in our own communities to identify and challenge policies that have profound effects on individual health.  For example, there is evidence that social determinants of health, such as poverty, lack of education and school nutrition have a greater influence on health than individual risk behaviors.   Considering this, it may be possible with knowledgeable leadership to eliminate some health risks altogether and to generally improve health care and reduce its cost.

Physicians can play a significant role in disease prevention by establishing themselves in particular communities, both their office and their residence, and by teaching a group of patients to be community health workers and organizers. Based on that kind of educational and organizational activity the clinic can become a cooperative that would grow to the size needed to support the physician and deliver primary health care to 1,500 patients.

Those of us who know about the health care problems and the potential solutions need to add our voices and labor to this cause: The Organization of Local Patient/Physician Cooperatives. From what we already know we can identify ways that physicians and patients can become involved in influencing community health policy. We can identify and describe the local economic, social, and environmental determinants of health relevant to the area we want to develop. By organizing physicians and patients around community health issues such as tobacco control, air pollution, food policy, or advertising to children, we can become a voice for change and influence the public policy that influences health. By teaching health care to selected patients who live in the community they will be enabled to organize their families, friends and neighbors to join the cooperative and establish the clinic. These trained patients will make up a health committee that will:

  1. Make the neighborhood secure so the physician and nurse can work freely and comfortably in the area.
  2. Accompany the physician or nurse on rounds to patient homes to show support and give confidence to the provider and the patient.
  3. Help collect and record all of the demographic and medical data.
  4. Promote “comprehensive community medicine.”
  5. Promote a culture of wellness.
  6. Analyze data and identify major ailments in the patient population.
  7. Help to fix the problems that are identified using the prescription of the primary care physician.
  8. Make the work real and the people involved accountable.

The teaching and organizing activities precede any delivery and financing systems for health care services. Once a primary care physician is in place and the community health worker team has been trained and deployed the patient membership can be built in such a way that the physician and the team know every patient on a first name basis and the medical problems that these patients need help in solving. In that process the social determinants of health care in the community will be well understood by the physician and the cooperative members so that root causes of bad health can be systematically addressed.

In a community with a population of about 50,000 people we should establish ten primary care practices on this model and over a period of two years enroll 1,500 patients into each coop clinic. If there is an average of 3 people in each household then we could expect 500 household memberships. Each community health care worker would be responsible for 50 households. That number is about the limit of personal contacts an individual can manage. Most of the time this kind of medical care and relationship building work is best done by women between the ages of 40 and 60, but there are exceptions.

Ultimately this development will allow the cooperatives to achieve goals and objectives not possible in the traditional healthcare systems. These are those goals:

  1. Put preventive care first.
  2. Train health providers to promote comprehensive integration of family health care in community life.
  3. Increase the number of physicians per patient in the population until it is 1 for every 150 patients instead of 1 for 417 patients as it is now in the United States.
  4. Reduce the cost of drugs by every means possible and introduce herbal medicines to provide alternatives to patients that cannot afford patent medicines.
  5. Place physicians in communities with the greatest needs.
  6. Raise the awareness of public health issues to lower mortality and morbidity rates
  7. Have physicians live among the poor to learn first-hand the sources of their illnesses.
  8. Increase primary care and improve specialist skills by making primary care their starting base.
  9. Start with “comprehensive general medicine” in neighborhood clinics and then form “basic health teams.”
  10. A team is a physician and a nurse and the volunteer health committee of ten patient members (the physician trained community health workers) assisted by a specialist team at the diagnostic clinics or specialty hospitals.
  11. The local team serves 1,500 patients ( about 500 households ). Specialty groups at diagnostic clinics can serve patients from 20 of these teams.
  12. The physician lives in the neighborhood and serves and is available 24/7.
  13. The physician and the nurse treat patients both in the clinic and in the patient’s home.
  14. These providers get all of the vital medical information and record it in the Electronic Medical Records system.
  15. The health committee members and the providers teach preventive care to every patient member.
  16. Each specialty diagnostic serves from 20,000 to 40,000 patients.
  17. Teams are thorough and attentive to each patient and know them all personally.
  18. The patients that are hospitalized are accompanied to the hospital by his or her primary care physician and the physician consults with the specialty team members that will care for the patient while he or she is hospitalized.
  19. Every specialist is also able to do primary care because they did that before becoming a specialist.
  20. Medicine in this setting is a science that is integrated with “real life” processes and is aligned with the quantum physics now assumed to be the truth about our world and universe.
  21. Identification of problems and interactive learning are used to increase cognitive independence.
  22. Epidemiology and Public Health are emphasized.

This common sense system and its goals cannot be defeated by adversity because it is a continuous process of overcoming problems that are far more complex and closer to the values of each person in the community than any general opposition that will arise because of pride or greed.

Within this network of cooperatives we can create a local university without walls to bring everyone that is interested into a fuller understanding of their role in the health care system, from patients, to health committee members, to nurses, to technicians, to sports trainers, to primary care physicians and to specialists.

New PPC / Patient Physician Cooperatives website and Portal is online!

Thursday, August 12th, 2010

We are excited to announce our new web site and portal is online today.   We still have a bit of work to bring some of the content up after the port,but it looks good and will provide much better access for our members going forward as we add content and features.

Our new URL is–Tony