Community forum: From an insider’s point of view, our health care has got to change

This week’s writer is Todd D. Gregory, MD, medical director at Rutland Regional Medical Center’s Emergency Department. He lives in North Clarendon with his wife and two sons.
I am an emergency physician at Rutland Regional Medical Center (RRMC), where I have worked for the last nine years. In addition, I have been afforded the opportunity to observe — and participate in — discussions and planning around healthcare reform at the community and state level.
There are many questions about what healthcare reform should look like and how it will affect us as patients, family members and providers of care. 
There is potential for great change, and this can be very unsettling. Unfortunately, anxiety of this magnitude sometimes tends to highlight differences in viewpoint and opinion rather than shared goals. It’s important to remember that as Vermonters, each of us has a vested interest in ensuring that Vermont has the best healthcare delivery system in the country.  I say this as a patient, as much as a physician.
I went into emergency medicine because I wanted to care for patients when they needed it most. The practice of emergency medicine requires us to treat every patient based on need, regardless of ability to pay, and this has also always been very important to me as a physician. If you are my patient, I want to ensure to the best of my ability that you get what you need — comfort, relief from suffering and top-notch medical care. For me, this mission is a fundamental part of my practice, and I will be the first to admit that it can be difficult to entrust others with the details of reforming the system that I work in.
However, it has become clear to me over the past several years that the way we deliver and receive care has to change. Healthcare in the U.S. and Vermont is too expensive, not available to enough people and not consistently of the quality it should be. 
If changes in healthcare work as designed, it will mean that more patients receive the care and attention they need in the comfort of their homes and communities rather than in hospitals and healthcare centers. Contrary to what one might expect, I have found that the healthcare institutions in this state recognize this and are willing to embrace changes that aim to keep people out of the hospital. Increasingly, it’s been recognized that what folks need to stay healthy is much more than the right medications or timely surgeries — it’s safe housing, enough healthy food to eat, and support with addiction and mental health problems.
We are making progress: In our ED, for example, we’re using a screening tool called SBIRT to identify patients at risk for developing addictions so that we can intervene earlier and hopefully prevent the suffering, illness and loss associated with these diseases. We’re working closer than ever before with community partners to provide more comprehensive services to those with addiction to alcohol, opiate medications and/or street drugs.
Will efforts like these mean less “business” for our Emergency Department, and possibly some difficult decisions down the road? Probably. However, our staff support these efforts. We see the consequences of these illnesses daily, and if we never have to tell another friend, loved one or family member that their loved one has died as the result of an overdose we will feel like we’ve won an important battle.
Without exception, each of the healthcare institutions in the state — large or small — is a nonprofit entity committed to caring for patients in its community. We care for community members, nurses, physicians and hospital administrators alike, and we often give or receive care to/from our friends, family members or neighbors.
I cannot spell out for you at this time what healthcare reform in Vermont will look like — and I’m not sure anyone can at this stage. What I can tell you is that Vermont’s hospitals and other health care stakeholders are deeply committed to ensuring that Vermonters receive the best care possible from the best healthcare system in the country. As a doctor and committed healthcare leader, I firmly believe that any changes we consider must be founded on better care for patients.

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