The Slow Move Toward Prevention



Years into implementation of the Affordable Care Act, physicians say the new regulations continue to put burdens on physicians while the intent of improving preventative care has failed to materialize. Now, they say, it is up to the community to improve health in their own families, and that they should not rely on government to do that job instead. “We as a community, we as individuals, we as human beings cannot wait for government to dictate or provide the ways to alter disease,” said Dr. Chippy Nalluri, a cardiologist at Heart Specialists of Sarasota. “It has to start at the grassroots, community level.” 

Physicians discussed the issue during SRQ Media Group’s most recent installment of the SB2 panel series, this one on the topic of “Taking Care: Advancements in Women’s Health Initiatives.” Within the discussion, the doctors spoke both of the challenges they face and the ones patients must deal with as well. “The Affordable Care Act was supposed to give everybody health care. It was going to increase costs, but on the flip side, someone who can’t afford insurance could get it,” said Dr. Lori Abrams, OBGYN at Abrams Center for Women. Many, though, still can’t afford that insurance, and those who have it are being affected in different ways. Most patients have $5,000 deductibles now, and even though well visits and treatment like pap smears and mammograms are covered, surgeries and other treatments are often declined by patients who can’t afford those services that go toward the deductible.

Dr. Elizabeth Callahan, dermatological surgeon and founder of SkinSmart Dermatology, said she supports changes like a move to electronic records and better sharing of information, but said physicians have to gather sometimes insignificant information on patients because of Medicare requirements. Practices also are required to direct 5 percent of patients to an online portal. “So we have gals with iPads engaging patients to go to our portal so we can make that 5 percent, which is ridiculous,” she said. But historically, Callahan said, physicians themselves have little lobbying voice on policy, as compared to insurance and pharmaceutical companies.

In the mental health area, Dr. Christina M. de Guia, psychiatrist, said many practices are no longer taking insurance. That means, for example, a parent relying on insurance who wants a child to go a child psychiatrist either ends up facing a two-month wait for an appointment or talking about similar issues with a pediatrician who may not be comfortable giving a psychiatric diagnosis. “I think this has been hard on the community, because a lot of people need to see psychiatrists,” she said.

Dr. John Fezza, cosmetic facial surgeon, said there needs to be a move toward preventative care, but neither the government nor pharmaceutical makers will be the force to make that happen. He noted doctors in school are trained with textbooks sponsored by drug companies, and doctors themselves need to find a own way to change the conversation toward prevention instead of just treating ailments. “We open up a pharma textbook and look at how to treat diabetes, and it’s with drugs by Plexor or Merck,” he said. “We are disease treatment-trained. How should we be trained? On preventative medicine. Has that changed? We’re making small changes, but we need to learn from one another.” 

Nalluri noted that in the cardiology field, many women die from diseases that could be easily prevented; 64 percent of women who die from heart disease did not know they had a condition before the event that took their lives. “Women are often the caretakers of the home, so this also goes back to their children and spouses,” she said. “We have to raise Americans’ interest in prevention. That will single-handedly get us out of the healthcare mess we are in.”

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