Health Disparities & Patient Diversity - Our Call to Action

Several weeks ago I saw a patient who exhibited many of the classic signs of depression, depressed mood, trouble sleeping, fatigue, and weight gain, so I administered a PHQ-9, a standard assessment tool for depression and confirmed my suspicions.  We discussed the diagnosis of depression, what it means and options for treatment, as is usual for my practice as a family doctor.  Usually, we (the patient and I) make progress in creating a patient centered approach to address their condition, but that day, I found my usual practice came up short.  

NHMS Testifies in Support of Raising the Tobacco Tax

Yesterday, I testified on behalf of NHMS in support of HB490, a bill to change the tax rate on tobacco products -- other than cigarettes -- to a price which is equivalent to the tax rate on cigarettes. The bill also proposes to establish a tobacco use prevention and cessation program.

I went through a few familiar points such as tobacco being the only legal product that kills 1/3 of its users; and 31,000 of children in New Hampshire today will die from a tobacco related illness.

NHMS Focusing Advocacy Efforts To Address Excessive Alcohol Consumption.

All of us know the human costs of excessive alcohol consumption. In our work we see the impact on individuals, families and communities in human terms. Problem drinking is something we see all too often. New Hampshire ranks among the top five heaviest drinking states. Some estimates place us first in per capita beer consumption while at the same time we rank 49th in access to substance abuse treatment. An estimated 96,000 residents are in need of treatment for excessive drinking but only 4% of them receive treatment.  Unfortunately, these statistics and our patients' stories have had little impact in garnering attention to expand prevention and treatment given the current economic environment until now. Last Friday, New Futures released a report that quantifies the costs of excessive alcohol intake on New Hampshire in dollars and cents and the results are shocking.

NHMS Explores Physician Buddy Support System to Help in Time of Need.

To test a physician's reflexes, one need only say the words "malpractice lawsuit."  Virtually all of us have a visceral reaction when we talk about litigation.  While the financial costs of malpractice are what dominate the headlines, the emotional toll associated with malpractice is often much higher.  Because of this, NHMS has been very active for malpractice reform with legislative solutions such as Early Offer, I'm Sorry, and the 519-B Malpractice Panel law.

It is important we remember that individual physicians who are sued often experience fear and isolation -- feelings that affect their confidence and that may alter, or even end, their practice.  Once a suit has been lodged against us, we are immediately instructed by our lawyers to not talk to anyone about it -- thus cutting us off from our personal and professional support networks.  This isolation may last years, as cases crawl through the legal system, and have long term effects on the individual physician.

Supporting Mental Health Crisis.

On Monday of this week, I joined representatives from a variety of health profession, law enforcement, and patient advocacy organizations to speak about the mental health crisis in New Hampshire.  The National Alliance on Mental Illness New Hampshire (NAMINH) organized the press conference to share new data on the excessive wait times for people in mental health crisis.  

At the time of Monday's press conference, 31 adults and five children sat languishing in hospital emergency rooms across the state waiting for a bed to open at the New Hampshire State Psychiatric Hospital.  Since July, there have been a minimum of 30 patients per week waiting for admission, with a maximum of 120.  You can read full  details here.

Staying True to Our Values.

Happy New Year!  Many bring in the New Year with resolutions to go to the gym, quit smoking, read more, learn a new hobby or skill and the list goes on.  I won't be joining the estimated 40% of Americans who make these resolutions.  Like most Americans, I'm not very good at keeping them.  Rather, I plan to revisit my list of values that help guide me in life, those  things and ideas that anchor me in my work and home life.  The busy nature of our lives as physicians often leaves us with little time to reflect on our days and what gives meaning to the work we do.   

Tragedy and Horror: Must Renew our Efforts to Prevent Violence.

Horrific events like last week's shootings shake us at our core, bring fear into our lives, and focus our thoughts on how precious and fleeting life truly is.  We ask ourselves why and seek answers so that we can prevent this from ever happening again. Unfortunately, these shootings are only the most recent in a string of violence and mass killings over the past 2 decades. The typical responses include that there are too many guns, or that there are too few guns, or that the mentally ill are dangerous, or that the mental health system is broken and severely underfunded.  Initially, there are calls for tighter gun control, looser gun control, and enhancing the mental health system. However, as we get further from each of these events, the energy and passion for prevention wanes, and we are then left with two highly polarized groups fighting over gun control sucking up all the airtime and energy for change.

Addressing the State's Mental Health Crisis.

The state budget cuts over the past two years have impacted the health of our patients and the public health infrastructure in many ways, but perhaps the most damaging cuts have fallen on those with mental illness.  In 2009, the legislature's budget resulted in the closure of 60 beds at New Hampshire Hospital (NHH) the state’s inpatient psychiatric care hospital.  The community mental health safety net took a significant hit as well.  While this made the budget look better on the surface, the problems associated with mental illness did not disappear and neither did their costs.  

Yesterday we received good news from the state. Health and Human Services Commissioner, Nick Toumpas, announced short term and long term plans to address the state's mental health crisis.  

Join Us in Supporting Anti-Smoking Efforts!

In 2007, NH passed the Indoor Smoking Act that went into effect, banning smoking in schools, child daycare facilities, hospitals, grocery stores, elevators and public conveyances (except when rented for private purposes), restaurants, bars, and private clubs when open to the public. Between 1991 and 2008 a total of 32 states passed similar smoking bans all of which were hotly debated but ultimately passed for a variety of reasons including the impact of second hand smoke on the personal liberties of nonsmokers. NHMS strongly supported the Indoor Smoking Act and we were proud to be part of the advocacy effort to pass the bill. You may be thinking, why is this newsworthy today?

NHMS Supports Important Health Policy Areas.

A central role of NHMS is to work on policies to enhance the public's health and the practice environment.  At our most recent executive council meeting, we voted on two important health policy areas:  

1.  The New Hampshire Society of Eye Physicians and Surgeons brought forth an issue that some hospitals were not open to negotiating their service call relationships with specialty providers.  Following a spirited discussion of the nature of service call and our professional obligations, we unanimously voted to support physicians as they seek to pursue meaningful negotiations in providing service coverage.