Local doctors, therapist talk healthcare

When it comes to healthcare, patient access to care is essential. That was the resounding echo in the room following a roundtable sit-down with Sally Dowling, MD, Kristine Griffin, MD, Sherin Howett, DO, and Joel Vanini, LCSW, three local doctors and a local therapist. These four practitioners have seen a slew of changes that have affected them and their patients, some good, some less so.

In breaking down the challenges and triumphs of healthcare on the local level, the doctors and therapist were candid in their experiences. On the positive side, Griffin cites the Affordable Care Act initiatives like coverage of pre-existing conditions as the most helpful provisions. She said, "A lot of patients weren't able to get coverage before because of pre-existing conditions."

This type of coverage, Dowling explains, leads to greater patient compliance with treatment because those who are covered are more likely to follow the doctor's advice. "Patients are more likely to get medical attention, more likely to proceed with tests, see a specialist, or take medication," she said. Vanini, who works in mental health, agrees that covering pre-existing conditions has helped across the board in her field, and clients are able to come in without being bumped because of their diagnosis.

Also on the positive end, Howett, in concert with the other doctors, expressed a dedication in Delaware to healthcare access. This includes Medicaid expansion, which has helped the Sussex County population obtain essential care with healthcare professionals in all areas of medicine.

Still, there are points on which healthcare needs improvement. Sussex County in particular faces a shortage of therapists, psychiatrists, primary care physicians, and specialists. Howett often feels frustration surrounding this point. "There are deficient resources here in Sussex County. There may be two endocrinologists in the county, and they might not be taking new patients," she said. "Then what do you do?"

On top of deficient resources, insurance companies often hinder the way doctors practice medicine, with increasing requirements for documentation, authorizations for testing, and prescription medications. Some insurers even require authorizations for generic medications, such as prednisone (a steroid used to treat allergic reactions and asthma flare-ups), which costs less than $5 out of pocket. As a patient, if you've had the experience of going to the doctor lately, and having the doctor feel rushed, staring at a computer screen, and then faced longer wait times for things like testing and prescription pickup, these doctors want you to know: they feel your pain.

When pressed on ways the system can be fixed, it's notable that all agreed improvements are needed, but not one doctor or therapist felt that the ACA should be repealed. Loss of coverage could impact some 30,000 Delawareans, and that could be catastrophic for the local population. Griffin said, "The ER then becomes the primary care, which is much more expensive." Howett said, "Patients will wait past the point that they should have. It impacts me as a provider because I am not seeing them or being able to keep up with my patients."

The solution, they unanimously agree, is not less healthcare, it's more. As they point out, access doesn't necessarily denote affordability, and that's an important key to making healthcare work. A public option which offers more reasonable rates could help private insurance costs decrease. But it goes beyond just providing healthcare; there also has to be a societal element, which everyone at the table felt included education. Using social media, standard media, health fairs, free public screenings and more, the healthcare field needs to connect with the community.

The bottom line for these providers is that they want to be connected with their patients as much as possible. Whatever healthcare system is adopted has to be centered on the patient-doctor relationship, because that is where care begins and ends. Dowling spoke for the group when envisioning what patients really need from health insurance. "They need the ability to have their healthcare covered financially," she said. "Patients need an engaged relationship with a provider who helps them proactively be healthier and helps to determine early on when they have illness or disease so it can be best managed."