Dialogue

Chardonnay J. Vance
 
 
Chardonnay J. Vance
 
chardonnay_vance.png
 

Year in Medical School: 1st

Place of birth:
 Camp LeJeune, NC

Where you grew up:
Minnetonka, Minnesota

College: University of California, Berkeley

Major(s) in College: Ph.D. in Comparative Biochemistry

Goals (medical school and beyond): To help humans bring their children into the world as healthfully, peacefully, and gracefully as possible.

Favorite quote: “Never doubt that a small group of thoughtfull, committed citizens can change the world; indeed, it's the only thing that ever has.
–Margaret Mead

 

Important facets missing from the health care debate are both an articulate, clear vocabulary and a positive focus.  It is hard to have any sort of constructive conversation or to solve any problems if our words are mis-representing our meanings.

As an example, I think of conversations I have had with people I've met out and about in Winston-Salem.  They tell me they are self employed or working for a small business, and they have no health care.  I remind them that if they head down to Baptist with a ruptured appendix they would indeed have health care, and very good health care at that.  What they don’t have is health insurance.

It is also difficult to have any sort of productive conversation about the cost of health care.  What our health insurance system seems to be is not insurance, something you try to never use like car insurance or flood insurance, but pre-payment and cost shifting.  Coming into medicine from my previous careers working as a midwife and scientist, I am shocked at how medicine is practiced with an almost intentional ignorance of the material costs and monetary resources involved in the course of diagnosis and treatment.

Perhaps this stems from our American idealism?  What creates health?  Money?  Luck?  Hard work?  Knowledge?  Responsible behavior?  And what creates responsible behavior?  I would say accountability in relationships, another key facet missing from most of our public conversations on health care reform.

My great grandfather chronicled his career as a general surgeon in Rupert, Idaho starting in the 1920s: he wrote extensively about health care reform of his day.  A big problem M.D.s had to cope with was “quacks”, people practicing as doctors with dubious techniques and potions.  The AMA was created as a way to for M.D.s practicing under a certain code of ethics to band together.  Their only advertising was a sign in the window, and their branding was their personal pledge to hold each other to a certain set of standards.  Necessity is the mother of invention?

I was shocked to learn at our recent WFUBMC Town Hall Meeting that there were physicians in the room who did not realize that our hospital receives tens of millions of dollars each year from the state to help pay for patients who cannot afford to pay for themselves.  As a midwife charging fees on a sliding scale and often giving away my services, I saw first-hand how people appreciated my services more when they paid a fair price.  This was across class and income levels.  When I charged too little or nothing at all, this was reflected in highly strained interpersonal relationships and disregard for my time and the skills I brought to the table.

Hopefully as a physician I can practice within a group or institution where both patients and practitioners know how much their health care costs and who is footing the bill. Patients and doctors should not be coming together through insurance company technocrats or lawyers and politicians: we can hire those people separately and negotiate with them on our own.  The physician-patient relationship deserves the respect and intimacy only a direct relationship, in all senses, provides.

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Last Updated: 04-23-2012
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