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Beyond the flow charts

"Beyond the flow charts" Continued...

Issue: "Dead heat," Sept. 22, 2012

The second theme that emerged from our research: Since lifestyles can contribute to illness, doctors who run patients through their offices as if they were machines needing a little oil are less effective than doctors who get to know their patients and talk with them about behavior.

Many clinics have wellness programs that target diet and exercise. Heffernan still spends two afternoons a week at Hope Clinic, primarily reviewing records to make sure no one falls through the cracks, and he insists upon seeing smokers: "It's crazy to give medication for their lungs and abdominal pains when it's caused by smoking, and they keep smoking." He tells them, "We'll lick this thing together."

A third theme: Charity clinics run on the work of volunteers, who seize the opportunity to take time with patients and personally help them. When Hope Clinic transformed from a Saturday-only clinic to one open during the week, Heffernan began volunteering two afternoons a week, giving up 20 percent of his private practice salary in order to staff Hope Clinic in its early days. Thirty years later, he still comes in Tuesday and Thursday afternoons. Five or six retired doctors also volunteer as often as every week, developing long-term relationships with patients "the old-fashioned way."

Heffernan says he has learned over the years not to ask doctors to volunteer too often. Hope has a regular Saturday morning rotation requiring doctors to work once every six weeks, and some doctors have done that since the clinic opened in 1982. The limited commitment is doable, leaving doctors time for their practices and family without burning out.

A fourth theme: Administrators at nearly every clinic spoke about the freedom to practice medicine without having to think about insurance or government reimbursements. They spoke of the damage government can do and the way it can transform into cash transactions what once emerged out of compassion.

Heffernan saw that firsthand. He ran his free clinic in Midland for a decade. Then federal money became available, and two neighboring counties applied for grants to create clinics for migrant workers in their areas. Heffernan says, "They got a $400,000 grant to do what we were doing for nothing."

In this issue we'll show how networks of care work and why many charitable doctors are concerned about Washington's expanding role in healthcare. WORLD's Oct. 20 issue will have Part Two of our report, with an emphasis on why doctors volunteer and how they help patients change self-destructive behavior.

Neither part is a systematic study similar to what engineers or economists might produce. We want readers to experience a little of what our writers experienced as they roamed the country. Our healthcare safety net can be understood best by immersion rather than through study of an organization chart. We were struck by the amazing assortment of clinics and helping networks, growing out of private initiative and generosity.

Nancy Pelosi famously said, "We'll have to pass the [Affordable Care Act] so that you can find out what is in it." Our writers this summer found what's in the existing charity clinic network, and were impressed. Can we preserve and expand it, or will we sing a line from an old Joni Mitchell song: "Don't know what you've got till it's gone"?

With reporting by Christina Darnell and Tiffany Owens

Susan Olasky
Susan Olasky

Susan pens book reviews and other articles for WORLD as a senior writer and has authored eight historical novels for children. Susan and her husband Marvin live in Asheville, N.C. Follow Susan on Twitter @susanolasky.

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