Archive for November, 2009
Sacramento County H1N1 vaccination clinics open to all today
Today marks the first day that Sacramento County’s free H1N1 vaccination clinics are open to all county residents, rather than limited to priority groups. Here is an updated list of free clinics through mid-January.
• Today: 3-7 p.m., Scottish Rite Masonic Center, 6151 H St., Sacramento.
• Tuesday: 3-7 p.m., North Highlands Community Center, 6040 Watt Ave., North Highlands.
• Wednesday: 4-8 p.m., Isleton Elementary School, 412 Union St, Isleton.
• Thursday: 10 a.m.-2 p.m., Samuel Pannell Community Center, 2450 Meadowview Road, Sacramento.
• Saturday: 10 a.m.-2 p.m., American River College, 4700 College Oak Drive, Sacramento.
• Monday: 3:30-7 p.m., Sheldon High School, 8333 Kingsbridge Drive, Sacramento.
• Dec. 9: 3:30-7:30 p.m., Maita Toyota, 3800 Florin Road, Sacramento.
• Dec. 10: 10 a.m.-2 p.m., Citrus Heights City Hall, 6237 Fountain Square Drive, Citrus Heights.
• Dec. 11: 3:30-7:30 p.m., Florin High School, 7956 Cottonwood Lane, Sacramento.
• Dec. 12: 10 a.m.-2 p.m., Franklin High School, 6400 Whitelock Parkway, Elk Grove.
• Dec. 14: 3-7 p.m., Mesa Verde High School, 7501 Carriage Drive, Citrus Heights.
• Dec. 15: 3-7 p.m., Folsom High School, 1655 Iron Point Road, Folsom.
• Dec. 16: 10 a.m.-2 p.m., St. Rose Parish, 5961 Franklin Blvd., Sacramento.
• Dec. 17: 3:30-7:30 p.m., Sacramento High School, 2315 34th St., Sacramento.
• Dec. 18: 3:30-7:30 p.m., Encina High School, 1400 Bell Ave., Sacramento.
• Dec. 21: 3:30-7:30 p.m., Rosemont High School, 9594 Kiefer Blvd., Sacramento.
• Dec. 22: 3-7 p.m., Natomas High School, 3301 Fong Ranch Road, Sacramento.
• Dec. 28: 10 a.m.-2 p.m., Robertson Community Center, 3525 Norwood Ave., Sacramento.
• Dec. 29: 10 a.m.-2 p.m., Sears-Florin Mall Drive-Through, 7000 65th St., Sacramento (no walk-ins, vehicles only).
• Dec 30: 10 a.m.-2 p.m., St. Anthony’s Church, 14012 Second Ave., Walnut Grove.
• Jan. 4: 10 a.m.-2 p.m., First Baptist Church, 4401 San Juan Ave., Fair Oaks.
• Jan. 5: 3:30-7:30 p.m., Elk Grove High School, 9800 Elk Grove-Florin Road, Elk Grove.
• Jan. 6: 3-7 p.m., Grant Union High School, 1400 Grand Ave., Sacramento.
• Jan. 7: 10 a.m.-2 p.m., Sunrise Mall Drive-Through, 6041 Sunrise Blvd., Citrus Heights (no walk-ins, vehicles only).
• Jan.8: 3-7 p.m., Inderkum High School, 2500 New Market Drive, Sacramento.
• Jan. 11: 3:30-7:30 p.m., Valley High School, 6300 Ehrhardt Ave., Sacramento.
• Jan. 12: 10 a.m.-2 p.m., Sacramento Japanese United Methodist Church, 6929 Franklin Blvd., Sacramento.
• Jan. 13: 10 a.m.-2 p.m., Christ Community Church, 5025 Manzanita Ave., Carmichael.
• Jan. 14: 10 a.m.-2 p.m., Sacramento City Public Safety Center, 5770 Freeport Blvd., Sacramento.
• Jan. 15: 10 a.m.-2 p.m., County Administrative Center, 700 H St., Sacramento.
Rural need is great, but docs are too few
Aurella Smith, right, talks with Mary Silva at the Sutter Amador clinic in Plymouth. Smith is in the Rural-PRIME program, which seeks to put more doctors in rural practice.
PLYMOUTH – If you really want to know what it’s like to be a rural doctor, clear your mind of all that “Northern Exposure” stuff. That’s just TV. The reality is more like the big city than you might think.
“Patients are patients,” says Dr. Catherine Leja, prepping for a busy morning at Sutter Amador Hospital’s clinic in Plymouth, “here or anywhere.”
Aurelia Smith nods knowingly. But Smith, a University of California, Davis, medical student serving under Leja in an eight-week rotation in Amador as part of the university’s Rural-PRIME program, punctuates that nod with a sly smile hinting that there might be a kernel of truth to the hayseed stereotypes.
“Someone got bitten by a raccoon that was trying to get her chickens,” Smith says, recalling a recent patient. “You wouldn’t see that in Sacramento.”
Nor is a third-year medical student in an urban milieu likely to experience the joy of having patients bring them, as tokens of appreciation, eggs and fruit they have harvested – or even wine that they’ve made.
And there’s this: “In a city,” Smith says, “the odds of you running into a patient you’re treating for high blood pressure out eating french fries are a lot lower.”
So maybe there can be a folksy, down-home feel to practicing country medicine. But there are also challenges – from a lack of reimbursement from insurance companies for Medi-Cal cases to a shortage of specialists available for referrals and a paucity of nightlife for younger doctors – not nearly as attractive as those eggs-and-wine perks.
Such perceived negatives, along with the fact that newly minted doctors often need big-city salaries to repay five- or six-figure student loans, have resulted in a severe shortage of rural practitioners in California and nationally.
Research by the California Health Care Foundation says 16 of California’s 58 counties do not have the recommended ratio of 80 primary-care physicians per 100,000 residents. Only 9 percent of doctors work in rural communities that are home to 20 percent of the state’s population. Moreover, the average age of the state’s rural doctors is 60, close to retirement for most.
UC Davis’ Rural-PRIME program was created three years ago to train doctors in rural and other underserved areas such as immigrant and low-income communities. The medical school has teamed with health care providers in Truckee, the Fresno County town of Reedley, Shasta County and the newest locale, Amador County, to offer future practitioners a taste of rural medicine – and maybe some homemade wine.
Urban-rural prejudice?
That’s how Smith found herself living for eight weeks in Jackson and working in nearby Plymouth this fall during her UC Davis family medicine rotation. She had already logged a pediatrics rotation in Truckee and a surgical stint in Sacramento and was about to return to Tahoe for the ob/gyn phase.
Students in the program hail from large metropolitan areas (New York City, San Jose), big-city suburbs (Fullerton, Arcadia) and smaller or isolated cities (Manteca, Redding). But Smith, 32, has lived in cities big and small – born in Iowa, raised in Los Osos (a town of 14,251 near San Luis Obispo) and educated at the University of California, Berkeley – and has made a commitment to practice in a small town.
“I don’t like the big-crowd thing, where it takes two hours to get anywhere,” she says. “In Berkeley, it wasn’t quiet, ever, and you couldn’t see the stars at night – things like that you find you miss.”
But medical students also quickly find there are conveniences that rural doctors miss having, simply because of remoteness.
“Physicians train in urban areas and get used to consultants at their beck and call – and get used to having high-tech (equipment),” says Dr. Robert Hartmann, a Sutter Amador physician for 21 years and mentor to UC Davis medical students. “So they have a fear of rural areas. It’s mostly fear of the unknown. What we’re trying to do is dispel that uneasiness.
“There’s a sense that people in rural areas don’t practice medicine of the same quality as those in the city. Part of it is an urban-rural prejudice. We are hampered by some of that. If someone comes in the ER and they need an acute angioplasty, they aren’t going to get it here. But you learn a broader spectrum of medicine being out here.”
Hartmann, who doubles as the county’s health officer, and Sutter Amador CEO Anne Platt say they have been trying for two years to hire an internist. (The previous physician left to work in a larger market because, Hartmann says, her lower rural salary could not hasten the repayment of her hefty student loan.)
The hiring has been tough going. But they hope mentoring UC Davis students might help with recruiting.
“We hardly ever get nibbles,” Hartmann says. “(Job candidates say) ‘You’re rural? You don’t guarantee salaries? You have to take care of people in the hospital and not let the hospital do it?’ It scares them off.
“We’re looked on as anachronistic.”
Smith acknowledges the drawbacks but didn’t think twice about aiming to practice rural medicine. A UC Regents grant and savings have helped her keep student loans to a minimum. As for the salary disparity between rural and urban doctors, she says, “Money’s not my main motivation.”
Making a connection and helping patients are what drives her.
“You get more patients here who want to be self- sufficient,” she says. “They don’t always come to the doctor right away. They wait until something’s really bad and say, ‘I can tough it out. I don’t need medication. That’s for wimps.’ Of course, that’s not everybody.”
Busy day, lots of learning
On a recent Thursday, Leja and Smith have a typical load, about 15 appointments. (A nurse practitioner in the clinics handles about twice that many in a day.) That gives the physicians the luxury to spend more time with patients. Half-hour appointments, highly unlikely in Sacramento, are common in Plymouth.
By lunchtime, the pair have seen a woman dealing with a shoulder injury that has not responded well to cortisone injections, a 14-year-old boy with a 104-degree temperature and suspected of having the H1N1 flu, and a middle-aged woman coming in for a Pap test.
The shoulder injury proves the most challenging. The patient had slipped at work last spring and, when swelling and pain persisted in her right shoulder, Leja referred her to an orthopedic specialist. No ligament or cartilage tear was found, and the specialist ordered physical therapy. When that didn’t ease the pain, Leja and the patient settled on acupuncture as an alternative therapy.
Now, one troubling symptom is an unusual coolness in the woman’s right hand.
“I think it might be RSD (reflex sympathetic dystrophy),” Leja tells Smith. “Feel the temperature difference. It’s pretty stark. But it’s not Reynaud’s (syndrome).”
The patient then shares aspects of her life not directly connected to the injury, and the doctors listen with interest instead of steering her back, big city-style, on point. Leja eventually writes a prescription for anti-inflammatory drugs, and the patient is on her way.
In an adjacent room sits the feverish boy and his mother. He’s wearing an Amador High football jersey and a glum look. He’s missed a week of school, has had a bad cough and a fever for days. Smith and Leja wear masks in case he does have the flu – though Smith already has had a bout with it, two months ago.
Leja instructs Smith to examine the boy. She listens to his lungs with a stethescope, looks over to Leja and says, “He does have some lung crackling sounds.”
Leja concurs but holds off on ordering X-rays.
“Do you want something with codeine that’ll knock out the cough at night?” Leja asks the boy.
Before he can answer, his mother quips: “The rest of the house does.”
After the patient needing a Pap test, Smith leaves the Plymouth office and drives to Sutter Amador Hospital, 12 miles away in Jackson, for lunch (a peanut butter sandwich and her fourth Diet Coke of the young day) and a consultation with Hartmann regarding a patient in the intensive-care unit who has had a tube inserted in his mouth and into his airway to be placed on a ventilator.
“There are teaching opportunities every day out here,” Hartmann says. “We see a lot of fascinating patients. Aurelia can go back to her classmates in Sacramento and say, ‘OK, these rural guys aren’t weirdos.’ “
And, in fact, Smith ends her workday with a three-hour UC Davis class, patched in to a Sacramento classroom via video teleconferencing.
A la “The Brady Brunch,” the screen is divided into squares with the students in Sacramento at top left, two students in Truckee at top right, Smith at lower right and a student in Redding at lower left.
The students hash out their experiences in the field and, when it’s time for Smith to tell of her Jackson stay, she talks about the day the power was knocked out at the Plymouth clinic after a storm and how the staff dealt with the hardship.
“Oh, and my cat had pneumonia,” she adds. “Who knew cats got pneumonia?”
Must be a city cat.
Many see state law as another barrier to more rural physicians
Dr. Robert Hartmann calls himself and other rural physicians “dinosaurs” – and you know what happened to them. But Hartmann, who has had a family practice in Amador County for 21 years, is working to ensure that a new generation carries on in rural medicine.
He does so by mentoring UC Davis Medical School students interested in working in underserved areas. But Hartmann, who serves as Amador County’s public health officer, also works for passage of state legislation that would overturn a long-standing ban on rural hospitals and health systems recruiting and hiring doctors directly.
“If a hospital can employ directly, doctors will be guaranteed salaries,” Hartmann says. “Those of us in private practice (in rural areas) don’t get paid as much as in urban areas, but our expenses are pretty close to theirs. I think that’s one of the things that need to be addressed.”
Toward that end, two bills aiming to lift the ban (Senate Bill 726 and Assembly Bill 648) are before the Legislature. (Currently, only state and county hospitals and clinics may employ doctors.)
The bills’ opponents say passage of either would promote putting corporate profits above patient care. As Dr. Luther Cobb, a member of the California Medical Association’s executive committee, wrote in an opinion piece in The Bee in September, hospital executives would focus on “the bottom line” and “foster divided loyalties and erode the quality of care.”
The opponents, which include the California Medical Association, say doctors can be recruited for rural areas by beefing up state and federal programs to help medical students repay loans and improving Medi-Cal and Medicare funding.
The bills’ proponents include the California Hospital Association and the California State Association of Counties. Anne Platt, CEO of Sutter Amador Hospital, calls the restrictions “antiquated” and an impediment to serving rural patients.
“I came from Colorado, where (hospitals can) employ physicians, and I think the fears are unfounded. (Hospital CEOs) are not going to dictate how physicians practice medicine. It’s just not going to happen. I’ve seen it at other hospitals.”
In 2004, the California Medical Board launched a pilot program that allowed direct physician hiring by select rural hospitals. Among the six sites selected were hospitals or clinics in Visalia, Mendocino and Mariposa.
Hartmann says he has heard of no friction between hospital administrators and physicians concerning quality of care.
“We need more programs like that,” he says.
Integrative Medicine: Don’t let stress ruin holidays
I am stressed and tired this holiday season. Many people at work have been laid off, and I have to pick up the slack. I am not sure if my job is secure, and I am dreading the holiday shopping and gift-giving due to finances. How do I stay healthy and keep a handle on my stress and fatigue this time of year?
The economy has been tough this year, and the added pressures of the holidays have been stressful for many of our patients. Here are a few simple things you may be able to do to create a healing and holistic holiday for yourself:
• Simplify. Be courageous and say “no” to excessive obligations or overindulgence. Think of ways you can downsize your presents, parties, eating and drinking, family obligations, extra work or holiday travel. Holiday stress and fatigue are aggravated by the extra activities.
• Boost your energy with exercise. Find ways to incorporate 30 minutes of exercise into your daily regimen, even if it means parking far away in the mall parking lot. You will decrease your stress levels and increase your energy.
• Sleep seven to eight hours a night. Chronic sleep deprivation increases fatigue and stress.
• Get some sunlight. Make sure you are in the sun at least 20 minutes a day to help boost your vitamin D and maintain your diurnal rhythm and mood. Take vitamin D supplements, too, around 1,000 IU a day.
• Take time for you. Try to get 20 minutes a day to yourself, away from TV. Read a book, meditate or listen to your favorite music – it will help you decompress.
• Heal with herbs. Lavender, lemon balm, chamomile, skull cap, red clover, black cohosh, Saint-John’s-wort and valerian can help decrease stress naturally. Many can be added to foods or taken in the form of teas. (Ask your doctor for any medication interactions before taking herbs.)
• Rethink your spending. A consumer study in October by Context-Based Research Group showed, surprisingly, that many people feel the recession has positively affected their mood. Many are focused on doing meaningful activities in place of spending: 50 percent of adults plan to give gifts in the form of volunteering, and 80 percent are spending more time with their family and friends this year.
• See your doctor if increasing depression, anxiety, fatigue or stress is affecting your relationships with others, your performance at work or your health.
• Finally, practice gratitude. Learn to love each moment and to live a life you love. This will allow you to reconnect with your good health this holiday season. Cheers!
Health policy very personal for Fiorina
U.S. Senate candidate Carly Fiorina talks to reporters in Sacramento after a speech earlier this month. She said recently that the breast cancer diagnosed in February “is officially behind me.”
Carly Fiorina launched her U.S. Senate campaign this month in a Garden Grove warehouse not with a promise or policy statement, but a simple question:
“What’s with the hair?”
Fiorina, 55, had short, cropped hair after undergoing chemotherapy this summer, telling supporters she was a breast cancer survivor and making it clear she planned to embrace her experience during the campaign.
In recent days, Fiorina has talked more about her cancer experience than she might have envisioned. After a federal task force recommended last week that women get fewer mammograms, Fiorina turned her breast cancer story into a new campaign message.
Fiorina, the former CEO of Hewlett-Packard, assailed the guidelines on various cable news shows. She told women to reject them and said she might not be alive if not for regular mammogram screenings and self checks.
Legislators in both parties have spoken against the guidelines for reduced preventive screenings, including Sen. Barbara Boxer, whom Fiorina hopes to unseat.
But Fiorina also has suggested the recommendations are a preview of health care under the federal overhaul that has been proposed, a position that plays well with the conservative voters she needs in the GOP primary.
Fiorina was diagnosed with breast cancer in February, had surgery in March and went through chemotherapy and radiation thereafter. Her aides acknowledged the disease throughout her treatment.
The time off may have slowed her efforts to win voters. She missed a September California Republican Party convention, and an October survey by the Field Poll found GOP voters more cautious about her candidacy.
A month later, she declared at her campaign launch that “breast cancer is officially behind me.”
“From Carly’s perspective, part of who she is to be open and transparent about that experience,” said Fiorina spokeswoman Julie Soderlund.
Candidates have disclosed more about their health in recent decades, particularly in an age when information spreads through various new forms of media, said Bill Carrick, a veteran Democratic political consultant.
“People used to hide their medical conditions, but it’s not possible now,” Carrick said.
Yet some candidates and officeholders, particularly older ones, have been sensitive about their health conditions. Former Los Angeles Mayor Richard Riordan did not disclose he had prostate cancer and underwent 44 days of radiation treatment while he was in office, revealing it only in preparation for his 2002 gubernatorial run.
Jessica Grounds, a Washington, D.C., campaign consultant and president of the Women Under Forty PAC, said female politicians are including their personal lives as a greater part of their political messages.
“It makes you real when you’ve battled this disease, and it’s a powerful experience,” Grounds said of Fiorina. “It’s a new norm to talk about personal experiences because it connects you to reality that people suffer from these diseases, and maybe it’s something she wants to take up as an issue as she runs for the seat. She strategically decided to talk about it in an upfront way.”
Fiorina has joined other Republicans in linking the U.S. Preventive Services Task Force’s mammogram recommendations to the health care overhaul under debate, suggesting that both are paths toward rationing care to save money.
“I think it causes people to say, ‘whoa, is this what government-run health care is about, is this what rationing health care is about?’ ” Fiorina told CNN last week.
The task force recommended that most women in their 40s don’t need regular mammograms, while those older should get them every other year rather than on an annual basis. Task force members have said they based their findings on scientific evidence, not cost, according to the New York Times.
Boxer is also opposed to the new guidelines and has signed a joint letter urging the Senate to hold a hearing to examine the new recommendations, according to Rose Kapolczynski, Boxer’s campaign manager. Kapolczynski took issue with Fiorina’s linkage to the health care debate, however.
“These recommendations did not come out of health care reform,” Kapolczynski said. “Fiorina opposes health care reform and the benefits they would bring to Californians. I think she’s using the outrage over these screening recommendations to bolster her case, but it just doesn’t make sense.”
Joshua Traviño, a spokesman for Assemblyman Chuck DeVore of Irvine, Fiorina’s primary opponent, said Fiorina hasn’t taken a tough enough stand against the health care plan because she says she agrees with the goals of health care reform, although not the current proposal.
“As a recent breast-cancer survivor, Carly Fiorina is well placed to speak on this, and it’s to be hoped she will use the bully pulpit to advocate the principles Chuck DeVore has spent his entire public career advancing: less government control, and more individual autonomy in making sound decisions,” Traviño said.
Senate candidate Carly Fiorina talks openly about the cancer therapy that led to her short hair.
