What do people really want?
Dr. Graeme Potter • Guest Columnist
As one of the practicing, board-certified OB/GYNs in the community who provide prenatal care, I’ve been honored to care for more than 800 babies born in Western North Carolina. When I moved here in 2007, I was first associated with a larger practice, and since 2008 most of these babies were delivered with my private practice, Dogwood Women’s Health, and more recently Dogwood Wellness. For much of this time, I delivered babies and did surgical procedures at Harris Regional Hospital.
For the past two years, my patients have gone to Mission Memorial Hospital for delivery; a process which has been enjoyable for both my patients and for me. The quality of care, and access to emergency care and the neonatal intensive care unit cannot be provided by any of the local hospitals. They also lack the resources to compete with the almost 100 percent breastfeeding rate I have attained partnering with the Mission staff.
Why do we have so many providers right now? It is not because of patient demand. The four regional hospitals in this area (I include Haywood Regional Medical Center and Murphy Medical Center) draw from all seven counties west of Asheville. Excluding Haywood County, these counties produce about 1,300 babies yearly, according to 2012 N.C. Department of Health data. Increasingly, many of these mothers choose Mission Memorial Hospital for their care.
Therefore, fewer than 1,200 deliveries and their prenatal care is divided between the three obstetric centers and the current census of 11 M.D. providers (including myself) and 3 midwives. Unfortunately, in recent years there has been only one practice associated with each of these centers, leading to a forced monopoly. At Angel Medical and Murphy Medical, both these practices are owned by the hospital. Competition becomes very difficult when the hospital has no incentive to recruit for a private practice.
When hospitals succumb to the corporation, the corporation becomes the focus, not the patient. Sadly, this has become more about corporate competition, more about corporate money than providing quality care. Within several years, the less effective providers will be called on the carpet when they cannot pull the impossible numbers that will be expected of them. Then there will be provider upheaval all over again.
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Although increasingly difficult, I have chosen to maintain a private practice. This is also one of the reasons that I have the freedom to work in the area of integrative medicine. I went into medicine because I care about people, your babies, your family. To this end, the decision to train with Andrew Weil, M.D., and return to a more integrative approach combines the best of all worlds. The focus is on you. Always. Creating and bringing a child into the world is a profoundly life-changing moment which cannot be adequately prepared for with routine medical prenatal care. In that moment of labor and with the call schedules now shared by all the practices, you have no guarantee who will be in that labor with you.
So the question for you as the patient should also be about the quality of the hospital at which you deliver. Is that hospital guaranteeing that the person on call can safely deliver your child, especially in an emergency situation?
Recently, my mother went for a consult for a surgical procedure. Her physician shared a list of potential complications. I have no way to confirm that his numbers are correct. The hospital for which he works can confirm them, but they are not public information. Hospitals provide numbers of these ‘complications’ to be compiled by organizations, but there is no way to verify accuracy. It is well nigh impossible for the average patient to access this list. Therefore, the patient really becomes “patient” — not pro-active — in their health care. Again, the focus becomes more about health care dollars than about patient care. Hospitals depend on in-patient and out-patient days financially, and complications are potentially bad press. Lawsuits definitely are.
Within each hospital there are committees of physicians, and they police themselves. By now, you can see where this is going. You know what happens behind closed doors. The purpose of my writing is to educate you, the consumer, the client who pays for all of this through insurance, taxes and deductibles. Ask questions, investigate. Get a second opinion.
You deserve quality; you deserve optimal care. No industry can self-police. There are too many variables, and we all know what happens.
Health care has become political. We can all too easily read an account of the “them versus us” mentality. We’ve lost many quality physicians in this area who refuse to practice corporate health care. They stood for the highest ideals. Like me, they got into medicine to care about people. The ones who remain would also like to practice to that standard, but their bosses are financial administrators, not health care providers.
I believe that people have a right to know when there is something that could potentially be hazardous to them. Advocate for quality. It is your right to hold hospitals accountable for the care that they offer to the community, regardless of how many providers they throw into the ring.
We need to create a new era in medical care and change this current situation into something that is beneficial for patients and allows providers to do their best work. To that end, I have also developed The Dogwood Insight Center, a 501 C(3) nonprofit corporation dedicated to providing sustainable health care, though community education and research, for this best model of health care.
(Dr. Graeme Potter is the medical director for Dogwood Wellness & The Dogwood Insight Center in Sylva.)
