By SUZANNE FIALA
For The Beachcomber
This is in response to the article in The Beachcomber titled “Health Center Struggles to Find Docs” (Oct. 24, 2007). As the article suggests, the physician staffing crisis on Vashon has less to do with national issues regarding the need for health care reform and everything to do with the local culture of expectations and burden of workload placed on the Island’s physicians.
The crux of that problem is the on-call system.
I am a Vashon resident and physician who, in the midst of making a career change earlier this year, interviewed at the Vashon Health Center. I liked and respected the physicians and felt they would have made terrific colleagues. I also loved the idea of working five minutes from home and my children’s schools. But I eventually turned down the job opportunity for primarily one reason — the call requirements.
Not since residency training have I been asked to be on-call for 60 hours at a time, to get out of my bed up to six or more times a night to tend to a medical emergency. Regular sleep deprivation was not the only issue. I was also concerned about the potential danger of unlocking a dark building at all hours to see a patient, not knowing if the call was legitimate or if a drug-seeker wanted access to the building by any means necessary.
I greatly respect the wonderful doctors who choose to continue practicing on the Island under these conditions despite the toll that commitment takes on their personal lives, but I was not willing to do it. And the more questions I asked regarding the type of nightly “emergencies” involved, the clearer it became that much of the workload of the current call system was unnecessary.
Those myriad nocturnal visits to the clinic include anything and everything from sprains, earaches and urinary infections to chest pain, respiratory distress and severe trauma. With appropriate triage, the majority of those after-hours visits to the health clinic would be eliminated.
Vashon is blessed by being part of the King County Medic One System — one of the premier emergency response systems in the country. Medic One has been used as a training model internationally, and it is no exaggeration to say that its medics are among the best in the world. They are better-equipped to handle true emergencies, where every minute counts, than the on-call doctor at the clinic. Medic One should be the first response to anyone suffering chest pain, shortness of breath, seizure, loss of consciousness, severe trauma or other true emergencies.
As to those calls at the other end of the spectrum — the cough and cold symptoms, earaches, early urinary discomfort, sprains and strains — these can be triaged by phone, and the majority can wait until the following day.
There also needs to be some patient accountability in the equation. If a baby develops an earache and high fever late at night, that child needs to be seen. But if a patient has had a cold or a bad cough for three days, some planning and scheduling of a daytime clinic appointment would certainly be more appropriate than a 2 a.m. call to the on-call doctor. Those middle-of-the night calls and visits to the clinic could drop to a fraction of the current status quo.
What needs to occur is not the spending of money and energy on national recruitment of new primary-care doctors, but rather a close scrutiny of what Vashon residents have come to expect from their medical community and a dialogue about it. The crux of the problem, as I see it, is that the public’s expectation of care from the Vashon Health Center needs to be renegotiated and redefined in terms of what is reasonable, sane and appropriate for both patients and physicians. Routine 24/7 access for an office visit at any hour, for any symptom, is just not reasonable.
I realize this column may be easily dismissed as the opinion of an uncaring physician. But I am a compassionate doctor who truly loves my profession. I recently opened a private practice in West Seattle where I maintain mutually meaningful relationships with my patients, several of whom reside on Vashon. Yes, good doctors are public servants. A desire to help others is what motivated most of us to endure long years of medical training. But boundaries and reasonable expectations have to be part of the equation in the doctor-patient dynamic.
To keep the wonderful doctors who are already on Vashon and attract more to their ranks, the public must treat them well, use them judiciously and afford them the same quality of life that drew most of us to live here in the first place.
— Suzanne Fiala is a family practice doctor who lives on Vashon and practices in
West Seattle.
