Doctors For Obama

Hello. My name is Suneer Chander, I am an ER doc in Framingham, MA.

Last week I pulled out my medical school application essay. After five years working as an ER physician, I had become so frustrated with my job, I was thinking about moving on to the business world. The essay reminded me that I chose to be a physician because I wanted to dedicate my life in the service of others. I realized that our broken healthcare system has made this very hard to do.

I recently took care of a young contractor who had shredded his hand using a saw and cut right through one of his tendons. This is a serious injury that requires expert attention. After cleaning and closing his wounds to the best of my ability, I referred him to an orthopedic doctor for outpatient surgery. A couple of days later, I called him up to see how he was doing. I was shocked to hear his story: he had called every orthopedic doctor in the area, but no surgeon would see him because he had no health insurance. This man is young, hardworking, and needs the use of his hands to provide for himself and his family, yet his lack of health insurance put his career and family in serious jeopardy.

On the last shift I worked, the paramedics brought in a 95 year old man who was found on the floor. No one knew how long he had been lying there. Our paramedics were horrified by the sight of this man's home. They described a disheveled apartment that hadn't been cleaned in months; no food in the fridge; and no signs of anyone helping. When I went to examine this man, he was covered in urine and stool that was days old. After taking care of him, I decided to call Elder Protective Services to report the situation. I was surprised to find out that they already knew about his situation and "see him regularly." The last time they saw this man was two weeks prior to his visit to our ED. This man has lived a long life and deserves dignity.

This is why I am so frustrated with my job. Our healthcare system does not allow paramedics, nurses, and doctors to take care of the people who need it the most: 1. hard working Americans who are simply trying to provide for their families; and, 2. elderly Americans who have worked so hard to make sure our lives are better than theirs.

In this election year, I believe that solving the healthcare crisis is the most serious issue on the agenda. After reviewing the candidates' plans, I have concluded that the choice is clear: Senator Obama's plan provides a road map to meaningful, realistic reform; Senator McCain's plan will make matters worse.

Under Senator Obama's plan, any American lucky enough to have insurance already will have the choice to stay with the plan they have. But, Obama will also create a new public insurance program available to anyone that will provide benefits similar to those provided to Members of Congress. This program will be affordable and attainable and will not discriminate based on pre-existing conditions. This will allow millions more Americans receive the quality medical care that they need and deserve. Experts predict the opposite effect if McCain's plan were implemented: millions of Americans would lose the health insurance they already have.

Obama's plan also renews our promise to seniors by strengthening Medicare. His Medicare reforms will lower prescription drug costs, eliminate the significant and excessive payments to Medicare Advantage health plans, and emphasize disease management and coordinated care programs for the many elderly with chronic medical conditions. And he will modernize the health care system by making the necessary investments in information technology and important changes to the way health care is paid for.

With this coming election fast approaching, I have been excited at the opportunity our country has to start fixing the health care system. I hope that when Barack Obama is elected our President, health care will be a right rather than a privilege. I believe that Obama's plan will help return our profession to what it should be: noble and dedicated to the service of those who need it most.

I chose to become a doctor after witnessing first hand the devastating health trends in my hometown of Detroit, Michigan. I believed that by becoming the "doctor" I could reduce the incidence of unplanned pregnancy, sexually transmitted infections like HIV/AIDS, intimate partner violence, gang violence, stroke, heart attacks, diabetes, etc.

My grandparents, did not have a doctor of their own. They could not say "Dr. X" is my doctor. Instead, they had and continue to have multiple doctors that change on a monthly basis contingent on who is assigned in the community for the month. Many of these physicians come to the community to get their loans repayed or to dedicate service for the government paying their tuition through medical school. Too often...these docs are not invested in the patients as much as they are invested in loan repayment. Who truly wants to come to an impoverished, health burdened community where patients tend to be noncompliant with their medications, show up late to appointments, mistrust the healthcare system at baseline and have very little comprehension of disease processes? It is much easier to take care of patients that are healthier, show up on time to their appointments and take their medications as prescribed. And did I mention...in these communities (the more compliant ones) the pay checks are sometimes 6 figures higher?

Well...I and some other docs I know want to ensure that people like my grandparents and citizens of communities like Detroit, Michigan have doctors that are invested in them, in their health, in their well being and understand and respect their unique needs.

So...I decided to become that doctor. I wanted people to be able to say "Dr. Anthony is my doctor" and it be a true statement. I wanted to dedicate my life to educating patients, being a contrbuting member of the community improving medical outcomes and reducing what I later learned were racial and ethnic disparities in health care.

So..I went to college at the University of Minnesota, attended medical school on the south side of Chicago at the University of Chicago (Senator Obama was our medical school class graduation speaker and I had the honor of attending meetings moderated by Mrs. Obama). It was at University of Chicago...I learned that public health affords one the opportunity to look at population health and improve outcomes of more than one person at a time.

SO...I went to Harvard and earned a masters of public health. Can you believe it? Harvard! It was the first of such accomplishments in my family and when I walked across the stage at graduation and saw my family rooting it was not only my personal accomplishment but that of my parents, grandparents and community friends.

When I chose a specialty for residency training, I chose women's health, obstetrics and gynecology. It is the one specialty that combines medicine and public health. A nation with healthy women bears a nation of healthy children and healthy men.

As an intern at Vanderbilt University Medical Center in the Ob/Gyn department I worked 80+ hours a week. I can tell you I often left the hospital exhausted. Sometimes physically but more times than not.. mentally. I was filled with a sense of failure and guilt. I'd worked so hard to get to this point in my career only to discover that the population I so desired to help was invisible. I felt guilty because the women who desperately needed our services could not get appointments. Women were sent to other clinics and hospitals with a phone number on a sheet of paper. I met women on my ER rotation who truly needed the care and assistance of our competent Ob/Gyn team but could not get access because they did not have the RIGHT insurance. These women had insurance but not the RIGHT one. Other women who were not insured had very few options.

It was only 8 months into my residency that we were told at Grand Rounds that Vanderbilt would no longer be taking Medicaid/Medicare for GYN services and only 1/2 of Medicaid for Obstetrics. This one decision changed my practice and my life. In one day, I lost 80% of my patient population. Patients I had taken care of majority of their pregnancy. Patients I had come to develop relationships with, saw in local grocery stores, was invited to baby showers, and personally called and checked on. We dropped them without a pipeline or referral. Patients called me desperate and told me no one would take NEW OB patients, especially those in the middle of their pregnancies for malpractice concerns. They were being charged $1.99/page for their medical records to be copied...and these were medicaid patients. So...they fell through the cracks and went without prenatal care for the duration of their pregnancy. When they went into labor they showed up at our hospital and we did not have their routine final trimester lab results because we dropped them from our care.

It required us treating all women with antibiotics because we did not know their GBS status. It required us spending more money to send rapid HIV tests because we did not have that information either. Pregnancy is a finite process (9 months + a 6 week post partum visit). I was bewildered that we did not have a "grandfather/mother clause" for existing patients. That unlike diabetes or heart disease we couldn't find a way to care for the existing patients we had until they delivered. I felt like a failure...like I had failed my patients. Patients that were doing the best they could, had actually sought out prenatal care for the health of their baby, had remarkable life situations. Most importantly these were women who reminded me of my neighbors...these were the women who lived and came from environments in which I was raised and left to become THEIR doctor.

How could I work 80+ hours a week, endure the crazy hours, volunteer not to have a social life and purposely stay awake on call non stop for 24+ hours when 90% of my own family, friends and their parents could not get an appointment to see me if their life depended on it.

I was disgusted and felt sick. I had worked so hard to get to this paramount "Dr. Anthony" point in my life only to learn that the poor and the poorly insured get less than ideal care. That you can indeed work to serve these patient populations but at the tradeoff of earning significantly less and working in hospitals and environments with less resources and specialists. This reality was all confounded by the reality that an MD from the University of Chicago and MPH from Harvard University cost me $217,000 gaining interest daily.

What could I do? I was a resident. My new clinic patients came with birthing plans, did not want their newborn vaccinated and knew about the latest prenatal pills with extra folic acid. They were honorary obstetricians at times. I enjoyed taking care of them but often wondered who was taking care of those less fortunate. I had many competent, compassionate physician colleagues that could deliver outstanding care to this population. I had colleagues who always intended to open private practices to take care of this populations. I realized that many of my colleagues chose medicine because of the science, biology, physiology and surgery. The patient was simply the vector that brought what they loved. I chose medicine because of the patient and the disease, science, surgery just came with the territory.

In addition to no longer taking Medicaid/Medicare we decreased the number of minutes per patient to 10 minutes. How can you see a patients, address their concerns, ensure fetal well being and educate the patient in 10 minutes. I know how...you can't. So...this is why the wait time for patients ends up being significantly longer.

What was I to do? This was not what I signed up for and I wanted to know why we were no longer taking care of sick people but taking care of people with the RIGHT insurance. I spoke with the chair of my department and was informed that it was a hospital decision and not that of the department. That there was nothing we could do.

I started speaking to my mentors and relating my concerns. The more I read the more the compass pointed towards the nations capitol. I had been involved politically in medical school and worked on Obama's Campaign for Senator. I wrote him and Dick Durbin about my concerns about the US Supreme Court Justices and Darfur. I knew there was a problem at a national level that extended beyond prenancy and prenatal care. I knew there were people with more dire situations.

I took inventory of my interests and discovered that my skills may be better suited in public health and policy. So...I left the traditional halls of medicine, hung up my white coat and I accepted an AAAS fellowship in Washington D.C. with the goal of getting acquainted with the national legislative process. To learn how one can translate their passion into action and action into legislation. So...I took my MPH and MD and committment to improving the lives women to Washington D.C. I worked at NIH and the Office of the Surgeon General. I ultimately ended up here...at George Washington University School of Public Health as a professor and researcher. I also consult at NIH and Office on Women's Health at HHS. Most gratifying is my work on the Hill with Congressional leaders to ensure that women and their unique health needs are not left off the political agenda.

I am now able to lay my head on my pillow at night knowing that the work I do impacts the lives of those I initially chose medicine for. A highlight of my career and confirmation of my decision was this past summer where I was honored by the Surgeon General for my service and contributions to the Surgeon General's Conference on the Prevention of Preterm Birth where we developed a national action plan to prevent preterm birth in the US. I can sleep knowing that the work I do somehow, someway directly impacts the health of a nation including those most vulnerable and those living in inner cities like Detroit, Michigan.

I am looking forward to and rooting for an OBAMA administration. I believe his healthcare plan is on the right track to ensuring that all Americans have access to quality health care.

I've learned there are a million ways to be a doctor. I miss seeing patients on a daily basis, bringing life into the world, operating, and having a doctor/patient relationship like no other. (In Ob/Gyn people tell you things they don't tell their spouses or closest friends...it is truly an honor). It is with the greatest hope and expectation that Senator (soon to be) President Obama reform healthcare ensuring all Americans can have access to their own Dr and be treated on the basis of their condition than their ability to pay. Only when healthcare is under reform...can I return with a weight off my shoulders... to the halls of the hospital and slip into my white coat with the embroidered "Dr. Anthony" on the pocket. Only then...can I return home at the end of the day knowing that I am a proud Obstetrician Gynecologist.. taking care of women...not because of their insurance status or ability to pay...but simply because they need the assistance of a physician and desire to be able to have a doctor they call their own. Dr. Renaisa S. Anthony.

Too many times during my training I have come in contact with patients who received inadequate care because of their lack of insurance. I had one patient sent home from another hospital after a heart attack, after being given a list of appropriate coronary artery disease medications that she should go to the county clinic for. After working on getting her county insurance set up, we finally had her able to get a cardiac catheterization, and she went for coronary artery bypass grafting that same day. That this woman was sent out of the hospital in the first place without prescriptions or proper care because of her insurance status is unconscionable.

The one patient that will always haunt me is a young woman in her thirties who developed heart failure presumably because of congenital heart disease and lost her job, lost her car, her home, her insurance. She had to move herself and her three children in with her mother. I remember her saying to me, "I did everything I was supposed to do, I love to work, but I just can't do it." Her heart function was so poor at this point, that she was under evaluation for a heart transplant, and on speaking with her, one of her fears was what was she going to say to her children about her heart failure, and would she be able to see her eldest child graduate from high school. Unfortunately, her transplant workup was postponed while we (myself, my attending, the social workers) had to work to get her set up medicare approval so that a cardiologist would evaluate her.

It is patients like this that make me support the Obama plan because these women would have had access to appropriate care and medications under his plan. Everyone should have access to health care, but when a physician's hands are tied in terms of doing what is best for her patient because of insurance, it is not right. I became a doctor because I wanted to help people, and I'm training to be a cardiologist to help women like the ones I've mentioned.

I am a pediatrician who works in a community health center in the Washington Heights area of Northern Manhattan. I am also an Assistant Professor of Clinical Pediatrics and Population and Family Health at Columbia University.

I recently took care of a little boy with asthma and developmental disabilities who lost his health insurance coverage because his mother who works part-time got "too much" overtime that year and he did not qualify for SCHIP anymore. Yet, his mother does not make enough money to purchase private insurance (she usually does not have that much over-time) and her employer does not offer benefits since she is part-time. This child was not getting needed care and services because of this lack of insurance. This is exactly the child who falls through the cracks in our current system and who Obama's health plan will help.

I have been an inpatient physician working at a county hospital in Ventura, CA for over 10 years. We are the safety net hospital for this county of roughly 1 million people. Approximately 70% of our patients are either uninsured or underinsured and because of this they have no access to regular physician visits, routine health maintenance and frequently can not afford to obtain the chronic medications that they have previously been prescribed. As such, their only interaction with the healthcare system is when they are acutely ill requiring hospitalization.

I have hundereds of stories of patients that I have cared for in the hospital for problems that could have been prevented, or at least minimized, if they had access to regular physician visits and identification or treatment of chronic medical conditions. Because the majority of the patients that I care for in the hospital do not have access to routine preventative healthcare, their chronic medical illnesses (e.g., diabetes, hypertension, chronic kidney disease, cirrhosis, chronic lung disease, asthma, hyperlipidemia, etc.)are not discovered and appropriately cared for and they eventually develop a complication of these chronic illnesses requiring hospitalization. In addition, patients do not obtain their recommended immunizations that protect them against preventable infections and do not receive routine cancer screening (e.g., pap smears, colonoscopies, bimannual exams to assess ovarian sizes, clinical breast exams, mammograms, prostate exams, etc.); as a result, they present with acute infections that could have been prevented or widespread cancer that could have been detected and cured in advance.

Their are hundreds of examples that I could share which illustrate this problem, however I will only share two stories. One story involves a young caucasion woman who was 29 and the single mother of two young kids. She had been working at two part-time jobs to try and keep a shelter over her family's heads and food on the table. Neither of her employers would offer her health insurance and she could not afford to obtain health insurance for her family. She presented to my hospital with a new severe headache and was found to have a brain mass by CT scan of her head. She was also found to have a large breast mass. Pathology of the breast mass and the brain mass both revealed infiltrating ductal breast carcinoma. The patient received whole brain radiation and palliative systemic chemotherapy and died within 6 months of her presentation to our hospital leaving behind two grade school kids.

The second story is a case of a hispanic man who presented to our ER in a comatose state and was found to have a massive intracranial bleed and severe hypertension. It turns out that he had been diagnosed with "alta presion" about 5 years ago. He was a field worker and could not afford his blood pressure medications on his salary. Because he was not able to obtain the medications and regular healthcare that he needed, he presented with a hypertensive intracranial bleed and expired in our ICU within a week despite maximal medical care.

These two cases point out two critical failures of our healthcare system. First, it emphasizes acute care medicine which by nature waits for a tragic event to happen and then tries to fix it. This not only can leave the patient in a chronically impaired state, but is very costly for the taxpayers. It also demonstrates how preventive care could have saved a couple of lives and in the long run would have costed taxpayers less.

Every day I care for somebody who could have benefited from universal healthcare and I yearn for the day when this will become a reality. I trust Barack Obama will carry through with his promise to make this a reality when he is the President of the United States.

I'm a board certified Internist and Pediatrician who practices primary care internal medicine and pediatrics. I've had the unfortunate pleasure of being both patient and physician, as I am also a two time breast cancer survivor.

I have patients with insurance, as well as patients without. I teach in a residency program, so many of those patients are underinsured and uninsured. However, in my faculty practice, most of my patients have some type of insurance. One patient who stands out to me is a newly diagnosed type 2 diabetic, who works and is in school to further her education. She pays for health insurance, and had coverage when I first met her. However, as we began to treat her diabetes, her insurance dropped her prescription coverage. Now this is a patient who was doing everything right: taking her medication as prescribed, exercising daily, losing weight, etc, but still required medication for treatment of her diabetes, eventually requiring insulin. However, she was forced to pay for her insulin out of pocket, and had difficulty with twice daily insulin due to her schedule (managing both work and school). Her diabetes was very well controlled with once daily insulin therapy and oral medication, but it's very expensive for her to continue the medications. Every month, she makes a judgment call on what gets paid for: her medications or other necessities. And in the end, her health suffers. It's so frustrating to have a patient who tries hard and still doesn't get a break, because the power lies with the insurers instead of the patient.

As a breast cancer survivor, I also know what it's like to need health care coverage. I can't imagine where I'd be without having coverage-likely not here writing this letter. After reading Senator McClain's plan, I get so frustrated with the lack of protection for patients with pre-existing conditions. One day I was a healthy medical resident, the next day I was a 27 year old cancer patient. Every American needs this protection, because we are all one diagnosis away from a pre-existing condition.

Medical Director of a mobile medical and mental health program for children in existence since Hurricane Katrina.

I was seeing a 13 year old young lady just last week who came in for severe headaches, decreasing performance in school, and occassional faiting spells and dizziness. These symptoms have been occurring for four months since a head injury in a river this summer! Her emergency room visit at the time of injury revealed a concussion for which she was to have neurological follow up. Immediately after the accident she returned to the ER four additional days for headaches and nausea. Her MRI did not reveal any bleeding or major concerns. She again was told to follow up with her Dr. and a neurologist. The problem was she had no doctor, no insurance, and no extra cash to pay out of pocket.

She now presents to our clinic (which is part of a Federally Qualified Health Center serving high risk families) for the same complaints with worsening school performance and questionable memory loss. When asked about the neurlogist the family responded that they have no insurance and had no means of paying for a visit. A recent job change in the family has made it more difficult for them to pay the bills that accumulated after the initial injury. There was no primary doctor before the accident which is why there were multiple visits back to the emergency room. Now she needs the neurlogy consult and further testing soon more than ever! Still she sits without insurance. Because mom had never applied for federal support before, she was unfamiliar with the rules requring an original birth certificate ,therefore, her initial application (1 month duration) was denied. She is awaiting the birth certificates for her family which could not be purchased until they had enought money at which time she will have to reapply for the insurance. We could be looking at an additional 2-3months waiting. At this point I can only treat her symptoms and had to be careful about the medication selection because pain medicines can be costly. I have advised her to return to the ER if she becomes suddenly worse. The insidious onset of new symptoms worry me. It is quite frustrating, irritating, and down right wrong that this family was caught in this situation. The mom is upset and feels she is letting her child down by not having the money to care for her properly. Now that my program is involved, we have a social worker who will work fervently to expidite her receipt of insurance and we will watch over her closley, we will call a neurology friend to help me care for her. She is just part of a long list of children who suffer because of a governmental system that does not value health for children, especially one's affected by economics. It is all too often that children are plagued by some unforseen mishap that brings tragedy to the family economically, socially, physically and mentally when the illness is compounded by controllable issues. If every child had insurance regardless, then so many stories like this could be avoided or certainly have better outcomes. I look forward to times like that!

Two years ago this month, I took care of an agent in Los Angeles. He had Crohn’s disease, and his health and nutrition had getting worse for over a year. He was seeing doctors at one of our private hospitals, but he lost his insurance, so he couldn’t see his doctors anymore. Buying private insurance was impossible - no amount of money could have convinced an insurance company to cover him. He tried the county hospital ER, but the wait was 24 hours. He thought maybe he could manage.

A few months later, when he could barely walk from his bed to the door, he tried the ER again. By then, he had kwashiorkor (the kind of malnutrition that famine-stricken African children get) as a complication of his gut disorder. Every organ system was failing. Even in the hospital, he tried to keep up his work via his Blackberry. We tried to help him, but he rapidly deteriorated and died six days after admission.

I was devastated and talked to many colleagues about what i could have done differently to save my patient. He should have been living his life and being a productive member of society today, but he's dead. We could have saved him if he had been able to come for care sooner. Ultimately, I recognize that he died because the system failed him. In our great country, that is unacceptable.