I must tell you all that I really had my installation speech ready in my mind by about one hour after being honored to be chosen as president-elect last year, but: Surprise!! The world and our own medical world have changed abruptly and drastically since then! So I have a motto for us to go by that is completely different from what I would have planned on before the pandemic, but actually is suitable all the time. And I did not create this, but have read it in several forms in the past: “I may not always have a say in what happens to me, but I always have a choice about how I respond to it.”
We will still go through the issues that I think are especially important to tackle, but of course I understand completely that the current priority is to get us back to taking care of our patients safely. How wonderful it is that Texans adhered so well to self-quarantining and social distancing and stayed away from our emergency departments and doctors’ offices if they had symptoms of respiratory illness; how wonderful that doctors agreed to stop all elective surgeries and testing such as mammograms and MRI’s; how wonderful that there was no surge of COVID-19 and we have thousands of available hospital beds and ventilators in Texas! But at the same time, doctors’ practices are in horrible financial shape, some may need to close down completely. Many employees now have no jobs. Even hospital-based physicians have had salaries cut and lost hours of work because the hospitals are half empty. Many of us placed ourselves and families in harm’s way, prepared to take on the surge of coronavirus patients that has not occurred. So obviously our top priority is getting back to work, but safely, and getting patients to understand that they need to come in with their chest pain and abdominal pain and stroke symptoms and not stay away due to fear of catching coronavirus, which is less likely to harm them permanently than the other problems.
Once the pandemic issues are getting under control, let’s respond in a stronger way than in the past for what needs to change, considering that the sacrifices we have made for our patients at the government’s request have cost us so dearly. Electronic medical records (EMRs) have turned us into data processing clerks. Yes, I know we will not be able to get rid of them, but we can insist they become interoperable between systems so they will be useful to let us see what diagnoses the patients have and what testing has already been done. Stop making it so hard to place orders or describe what is going on with a patient solely because administration and the billing department require clicks for everything, even if the choices are not correct. Let us type in what we want to order and what findings we want to describe and have clerks find click marks that fit properly if they must do so.
We must stop administrators from holding us to metric systems that are not good for patient care. Hospital based physicians and physicians now employed by hospital systems are expected to see a certain number of patients within certain time frames, or conform with other metrics, or they potentially will lose their jobs. The physicians are doing the best they can, but patient care will be compromised, especially without enough time to properly evaluate or care for the patients.
Physicians have not received a pay increase from Medicaid in twenty years. Many physicians cannot afford to take Medicaid patients at all, but others have no choice due to their type of practice. Many physicians truly want to help people on Medicaid, but cannot afford to take a loss in order to do so. The legislators believe that physicians will continue to care for these patients no matter what, and we must be more vocal about not being able to afford to continue the care. Their constituents will end up being more of a financial burden on the taxpayers because they will not get care in a timely manner.
How have we developed such an adversarial position with insurance companies? We should all be working together to support each other, but instead, the insurance companies have become our enemies. Patients are paying huge premiums and expect that they are covered for medical care, especially after they also have large deductibles to meet and copays to cover as well. Then the insurance companies end up paying much less than is billed, or even worse, tell the patient that their visit to the emergency department or their surgery or procedure was not necessary and is not covered by the insurance company. This even happens when the patient is in excruciating pain, or comes in with chest pain or other potentially serious complaints, and the insurance has no moral right to deny coverage that the patient is paying huge amounts of money for. And what happened to the rule of “prudent layperson” definition of an emergency? The health insurance companies are now completely ignoring legislation that instructs them to cover emergency fees for a patient who, as a prudent layperson, believes they need to go to the emergency department, even if the final diagnosis is not as emergent as they thought possible. Once the insurance companies realized there was no or minimal financial penalty to ignore the rule, they now do so with no regret. Insurance companies, with profits in the billions of dollars, have so many legislators paid well with contributions that we are at a huge disadvantage to be treated fairly, as are the policy holders. Our only hope to deal with this issue is to have multiple constituents of the legislators to complain enough that it will make a difference to them.
We hear a lot about burnout of physicians these days, even residents and medical students. I strongly believe that burnout can be prevented by participating in organized medicine because it helps so much to not be isolated and to have a group of physicians (or residents or medical students) trying to make a difference that one physician by himself or herself cannot change. It is amazing how many long-lasting friendships are made by being on a committee or council, in the county medical society or TMA or AMA or specialty society. We need to get that word out right away!
This has been the first Texmed meeting that has been cancelled since World War II, and this installation and saying farewell to Dr. Fleeger in this manner is both historic and unique. I am honored to be able to share this moment with our members via video stream since it cannot be delivered in person. In case this video is viewed in the distant future and folks don’t realize our restrictions, we are limited to a maximum of ten people in a room. I wish to recognize the presence of Dr. Fleeger and his wife, Jamie; and Dr. Linda Villarreal, chair of the Board of Trustees; Dr. Gary Floyd, vice-chair of the Board of Trustees; Dr. Arlo Weltge, Speaker of the House of Delegates and my guest, who has been with me through thick and thin since we were in medical school at the University of Texas Medical School at Houston and graduated together forty-two years ago; Dr. Michelle Berger, secretary-treasurer of the House of Delegates and my guest, who has been my great and supportive friend for many years now; and Dr. Robert Emmick, a fellow emergency physician and my guest, who has been a close friend for over thirty years. Also I am honored to recognize Senator Dawn Buckingham, the well-respected state senator from district 24, who is an oculoplastic and reconstructive surgeon and has been a friend for many years.
But I do miss badly my family and several other close friends who I had been planning all year long on being here. Those friends would be Dr. Pat Woods and his wife, Dr. Dana Woods, Pam Munson and Matt Munson, and Linda Hollar, my best friend from Amarillo since we were in junior high school, with her husband, Harlon Hollar. Linda and Harlon were planning to bring along my mother, Sylvia Ellis, who is 92 years old and was really looking forward to seeing be installed as TMA president. Also missing from this event are my eight children, Tracy Patton; Anna Floyd who passed away but was going to be represented by her husband, Scotty Floyd and his mother Debbie Holman, with grandson Ryan; Arthur Patton with his friend Brittani Pulsifer; Elizabeth Carlile with husband Chris Carlile and grandchildren Michael, Lily, and Catherine; Alexandria Patton with her friend Jake Bice; Renee Munoz with husband Christian Munoz; Aaron Patton; and Amanda Patton with her friend Sara Goodell. Some of the grandchildren were too young or otherwise would have been unable to attend. And thank you, to God, for letting me continue to pursue my purpose in life, to be a physician, now as TMA president.
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