Insurance Doesn’t Guarantee Health Care Access

angela-mossBy Angela Moss, PhD, RN, APRN-BC

Health insurance is a common proxy measurement for access to health care services. That is, if a person has health insurance, they also have access to health care services and time to seek regular visits. Unfortunately this isn’t always the case.

A new Gallup-Sharecare Well-Being Index shows the number of adults without health insurance is up 3.5 million this year. But those with health insurance also may not have access to doctors, nurses or clinics.

One of those Americans is my patient; I’ll call him Joe. He has worked two full-time jobs for all of his adult life. Joe is 57 years old and regularly works the evening shift six or seven days a week from 2 to 11 p.m. in a distribution factory operating heavy machinery. He then clocks in for his night shift warehouse job at another factory from midnight to 7 a.m.

For nearly 30 years, Joe has had about four hours of sleep a day between 9 a.m. and 1 p.m. He smiles proudly and says he supported his family with his tough schedule. He put three kids through college and now all three are independent, successful professionals who are free from college loan debt. He and his wife own their home and two vehicles outright.

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Patients, and Providers, With IBD

ottenheimer-harmeier

As physician assistants in the Section of Gastroenterology at Rush, Jenna Ottenheimer and Emily Harmeier often diagnose patients wtih ulcerative colitis and Crohn’s disease, the two forms of inflammatory bowel disease, or IBD.

But their experience with these conditions isn’t just professional: Jenna has ulcerative colitis, and Emily has Crohn’s disease. Both are lifelong, chronic inflammatory disorders of the digestive tract that are treated with medications and often with surgery.

Recently, Jenna and Emily sat down to talk about their unique positions, and how their personal lives inform their work with patients.

Jenna: I’ve been a physician assistant at Rush for almost three years now. My decision to work in this field was strongly influenced by my own diagnosis of ulcerative colitis. After spending many years as an IBD patient, I felt that I could relate to my patients as a provider, and that’s why I decided to work in gastroenterology.

Emily: I had similar reasons for joining our practice as a PA nearly two years ago. While the majority of my patients don’t know that I have Crohn’s disease, I think I bring a unique perspective on topics that can oftentimes be both embarrassing and personal. Having been a patient myself for over a decade, I have learned to be the type of provider who I would want to take care of me.

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Tolerance

toleranceJames Herrick, MD, was a renowned Rush Medical College graduate and faculty member credited with identifying sickle cell anemia. He practiced at Presbyterian Hospital, which later became part of Rush.

Rush archivist Nathalie Wheaton recently came across the following article, from the Presbyterian Hospital Bulletin, about a speech Herrick delivered shortly before Christmas, 1937.

Herrick_from-1910-class-comDr. James B. Herrick, a practicing physician for more than 50 years and a member of the Presbyterian Hospital Medical Staff since 1891, was the speaker at the Sunday morning service in the chapel of the University of Chicago, Sunday, Nov. 13. Some excerpts from his inspiring address on the subject of “Tolerance” are especially appropriate at this season when we are reminded of the angels’ song of peace and goodwill on that Christmas night of long ago.

After pointing out that the doctor has an unusual opportunity of seeing life both good and bad, because “he sees people just as they are,” Dr. Herrick said that “a true doctor has a dual personality. Toward diseases he must be impartially, even coldly, scientific. What is the nature of the illness? What can be done to ameliorate or cure it? Can it be prevented in the future? Toward the patient, however, the doctor must be sympathetic, in the derivational sense of the word — suffering with the afflicted one, whom he views not alone as a ‘case’ but as a thinking, feeling, timorous human being.”

“Tolerance” said Dr. Herrick, “is forbearance; it is the exercise of patience and charity toward one whose opinions or acts we do not approve. While we may condemn the deed, we do not necessarily condemn the doer. Though we believe our opinion and behavior are right, we do not, except by persuasion, education, or example try to induce him to give up his own view or to adopt our practice; unless, it must be added, he is periling society, for there is a limit even to tolerance. Intolerance, on the other hand, is offended by, and unwilling to put up with, opinions that differ from our own.

“But many of the differences that estrange people are not serious; they are largely due to the accident of when and where one was born; they are matters of race, country, custom, environment.

“Surely there are more common characteristics that should unite people than differences that should separate them. No one nation, no one race, no economic, intellectual or social group has a monopoly of the higher attributes such as honesty, kindness, idealism.

“So the doctor, as he grows older, learns to look upon people as, after all, very much alike. The question is not whether one in trouble is of this race or religion or that; whether he is cultured or ignorant. The question is whether the individual is ill or thinks he is. If so, the doctor tries to help him. Should not others, even those in high authority, have some such view of people as has the physician? A more liberal recognition of the brotherhood of man would help solve some of the troublesome problems of the day.”

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Obamacare: More Success Than Failure So Far

peter-butlerBy Peter W. Butler, MHSA

More than six years after it was signed into law, the Affordable Care Act continues to arouse strong opinions and strong objections. Consider, for instance, the viewpoint made clear by the title of a Sept.11 Chicago Tribune editorial, “Why Obamacare Failed.”

Simply dismissing the ACA as a “failure,” however, is not supported by the facts when considered in the context of what Obamacare, as the ACA is more widely known, set out to accomplish. According to the obamacarefacts.com website, the goal of the Affordable Care Act is to “give more Americans access to affordable, quality health insurance and to reduce the growth in U.S. health care spending.”

Although some of the editorial made valid points about problems with state health insurance exchanges (marketplaces), especially in Illinois, the exchanges are a small part of Obamacare. The Tribune editorial board appears to have reached its conclusions based on premium increases and the limited number of choices available on the state exchanges.

How the ACA has helped

This view ignores a wide array of peer-reviewed data that examines the full impact of the ACA. These data and evaluations present a health care system that is performing much better than it was prior to the enactment of the ACA.

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Fantastic Faculty

Eight outstanding faculty members were honored at Rush University’s 2016 Faculty Recognition Reception. Each was given a Rush Faculty Excellence Award for their contributions to the personal and professional lives of countless patients, families, colleagues and trainees. Click an image for more information about each faculty member.

‘You Have to Give People the Chance’

Despite his visual impairment, Muhammad Ullah and his family didn’t even know he had a disability when they immigrated to the U.S. Once his condition was diagnosed, it enabled him to receive help on his way to becoming a medical student at Rush.

Ullah credits the Americans With Disabilities Act, which celebrated its 25th anniversary last July, with opening doors for him. “You have to give people the chance,” he says. “It might not work out, but they can come in and they can do their best and contribute. … That’s what the ADA does … it really gives people opportunities.”

‘To the Level of My Peers’

Michael Welch was a professional musician and dancer until his mid-20s.

“Then I had a pretty gnarly, high-speed biking accident that put me in a wheelchair,” says Welch, who spent two months in a hospital recovering from his injuries.

“I was inspired by the medicine that was happening around me, so I chose to go into medicine,” he says.

And Welch applied to Rush Medical College.

“During the interview process and the application process, I really didn’t bring up my disability, and neither did anybody that was interviewing me,” says Welch, now a student at Rush. “It was great to have that level of respect for my independence.”

After he arrived on campus, Rush helped him get a standing wheelchair that enabled him to participate in cadaver dissection.

“They helped me get the funding for it, and to acquire it,” he says, “and elevated me, quite literally, to the level of my peers to make the curriculum entirely accessible to me.”