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Progress Notes features doctors and medical students across the country on the frontlines of our health care system. Our views and experiences are diverse, but we share common goals and values. We speak up to move toward a future where everyone can have access to affordable, high-quality health care. Please share our posts, and follow us on Facebook and Twitter!


Health Care Reform in East Harlem

By Andrea Jakubowski
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The DFA National Conference in April of 2013 came at an incredibly exciting time. The health insurance marketplaces were set to launch October 1st, Medicaid eligibility had expanded, and we were witnessing a historic step towards improving American’s access to health care. As a group of Mount Sinai medical students new to DFA and attending the conference for the first time, we were caught up in the excitement. But we also learned the sobering fact that millions of individuals who would be newly eligible for Medicaid or private insurance on the marketplace weren’t aware of how health care reform could benefit them. Doctors for America had helped pass the ACA and defend it from attack, and now we would need to help with its implementation.

Our group of medical students came away from the conference impressed by the urgency and importance of helping spread the word about health care reform. Mt. Sinai is located in East Harlem, a neighborhood with a high burden of disease and many barriers to health care access. Students at Mt. Sinai have a long tradition of working and serving in East Harlem, and we began brainstorming how we might bring the message of health care reform to our patients and fellow community members.

We decided to start a Mt. Sinai Doctors for America student chapter. We knew we wouldnt be working alone in East Harlem, as the neighborhood is rich in trusted organizations serving devoted clients and patients. Our first step was to form a partnership with the East Harlem Community Health Committee (EHCHC), a coalition of community organizations with a history of working on implementation of health policy changes in the community.

Our goals in forming the partnership were: 1) Educate East Harlem residents about new options for health insurance and how to enroll 2) Describe and document East Harlem’s experience of enrollment from the perspective of community organizations and 3) Facilitate communication and collaboration between community based organizations (CBOs) working on enrollment.

A group of twelve medical students, we dedicated ourselves to forming partnerships with local organizations, including three major community health centers and two large social service agencies in the neighborhood. From September 2013 until the end of the open enrollment in April 2014, we gave nine presentations with over 115 in attendance, including for a NYC Department of Health ACA forum, part-time staff of Union Settlement Association, clients of several small community organizations, and the Mt. Sinai medical community. We tabled at health fairs and tax clinics, talking with attendees about the ACA. Finding that the outreach resources from the state marketplace often lacked adequate information about eligibility and how to apply for insurance on the marketplace, we created over ten outreach documents in English and Spanish that we used and shared with navigators and many organizations in the neighborhood.

One our group’s most significant contributions was creating linkages between organizations in East Harlem. Working closely with a certified application counselor, students were able to invite her to several of our community presentations and connect East Harlem residents with her services if they needed assistance enrolling. Every month, we presented updates at the EHCHC meetings to share what we were learning through our outreach and enrollment efforts and to generate discussion about how we, as a community, could strengthen our ACA work.

Now, a year after the health insurance marketplaces launched, it seems clear that the health insurance marketplace has been a great success. In New York State, there were approximately 2.7 million uninsured before the launch of the Marketplace. By August, the number of uninsured was just over halved, with 1.4 million signing up for insurance. But as impressive as these gains are, there is still work to be done. Building on the lessons we learned through our work, we are excited to continue our efforts in East Harlem and throughout New York City to keep spreading the word about the ACA and getting covered.

Andrea Jakubowski along with the Icahn School of Medicine at Mt Sinai Student Chapter of Doctors for America

 

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Call for coverage

By Donald Nguyen, MD
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The deadline for open enrollment is this Sunday. Join me and Doctors for America members across the country in spreading the word out about the final week to enroll for 2015 health coverage.

On Saturday February 14, we are going to help connect Americans with health insurance by picking up the phone to talk with consumers about where and how they can enroll.  It’s something you can do from your living room.

You can make calls in three easy steps:

Step One: Request a Phone List
If you want to host a phone bank or make calls on your own, fill out the Request Form and you will receive the call link and script. Please fill out the request format least 2 days before you plan to make calls.Important: If you are going to phone bank with us on 2/14 be sure to request your form by Friday.

Step Two (optional): Get Friends to Join You!
Once you’ve filled out our Request Form, get ready to make your calls! It can be more fun if you recruit friends to make calls with you, or you can make calls on your own. Everyone needs a computer and should have some time to get familiar with the script. Please note, you may get a list of phone numbers for another state, depending on where the need is greatest.

Step Three: Make Your Calls! You never know whose life can be saved or touched with the knowledge of the new health coverage now available. Pick up the phone and make your calls! 

Don't forget to take a picture and post it on Facebook and Twitter using the #getcovered hashtag or just send it to us, and we'll post it for you!

 

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Why Young People Should Get Enrolled

By Jose Tapia, DFA Intern
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Young people my age tend not see the need to enroll in health insurance. Many of us assume that we are way too young to get sick, and that the Affordable Care Act, or “Obamacare,” was passed only to help older, sick people. The reality is that we all can get sick at any age or suffer from an accident.

A friend of mine named Emily who is the first to go to college in her family, is a prime example of the need for health insurance at our age. She currently suffers from Irritable Bowel Syndrome (IBS). It’s a chronic condition that affects a person’s digestive system. Typical symptoms include severe stomach pain, nausea, tiredness, and diarrhea. There is currently no cure for this condition, only long-term treatment. Emily lived her entire teenage years as healthy as many of us did, until IBS symptoms arose from no apparent cause at the age of 19. Physicians do not fully comprehend what caused her condition.

Her symptoms quickly escalated and followed her through college. Emily’s parents could not afford private insurance, and she did not qualify for Medicaid in the state of California at the time. Her only viable alternative was to turn to free clinics in her community, but sadly wait times and limited resources prevented her from receiving the care she needed. Emily’s condition worsened so much that she had to drop out of college. She realized that the only hope she had to see a physician was to go to Emergency Room and wait for countless hours, and sometimes even days.

After President Obama signed the Affordable Care Act into law in 2010, Emily was able to receive health care coverage. The ACA expanded Medicaid coverage, and she was now able to qualify for the program. Being covered under Medicaid allows Emily to receive the treatment she needs for free. Having coverage meant she was able to receive the proper exams needed to diagnose her condition, and a specialist has been able to properly treat her condition with medication. This treatment has allowed her to go back to college and continue her undergraduate studies. She was able to regain control of her life, no longer having to live with constant, debilitating pain.

Once Emily graduates from college, she may obtain quality and affordable health care coverage through her employer. There are other simple ways Emily can get covered even if her employer doesn’t provide her insurance, or if she works in a nontraditional job. Many nontraditional jobs do not provide health insurance- common examples include baristas, waitresses, retail workers, and self-employment. If that were the case Emily could still very easily obtain insurance, and the costs could be as affordable as a monthly cellphone bill thanks to a provision in Obamacare that could help her pay for health insurance. Additionally, there is another important provision in Obamacare that now prevents insurance companies from denying Emily health coverage simply because she suffered from an illness in the past.  

We can all learn from Emily’s experience. Just because we are young does not make us completely immune to disease or accidents. Plus, with the passage of the ACA it’s now more easy and affordable to obtain health insurance than ever before. Today Emily is 25 and is a great example of why young adults should enroll in health insurance. She is thankful for the passage of the ACA and California’s choice to expand Medicaid access. The benefits the ACA provides are not age- restrictive, and we should all be conscious of our need to get enrolled. To learn more check out this link for an easy and interactive presentation on enrollment health.younginvincibles.org

To get covered and take advantage of all the benefits the ACA has to offer, enroll online before the February 15 deadline: www.healthcare.gov

- Jose Tapia, DFA Intern

 

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MLK Day of Service

By Dr. Manisha Sharma
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“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” 
– Martin Luther King, Jr.


The enrollment deadline is fast approaching. It’s not too late for you to help your neighbors, patients and friends get health coverage before February 15th

Let’s come together on Martin Luther King Day of Service and honor Dr. King by helping educate our communities about the importance of getting covered.
 
Not able to attend an event or don't see one near you?  Share this graphic on Facebook and Twitter to remind people to get covered. And, don’t forget to use our pocket card to learn how to screen patients for health insurance, answer basic questions, and point them in the right direction.
 
Together, we can improve lives and ensure everyone has access to the care they need and deserve.
 

 

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This is what we did together!

By Dr. Alice Chen
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It is hard to put into words how proud I am of the DFA movement.  

Over the past year,
 we have led a diverse coalition to get Dr. Vivek Murthy confirmed as Surgeon General. We have commanded people to hope where they thought hope was folly. We have brought together the medical community, the public health community, and a wide array of partners from all over the country to Stand with Vivek

We got the United States Senate to confirm him, and every piece of what you've done has made that possible. Your support is what makes this organization robust and powerful.

We have all enjoyed Dr. Murthy’s extraordinary leadership since our movement began. As we get ready to share him with the rest of the country and as we wish him well in his new position, I think it is important for each of you to know that this confirmation is not victory for just one person.

The groundwork for Dr. Murthy to defy all odds to become America's Doctor has been laid by doctors and medical students across the country who, for the past 6 years, have challenged the common perception that doctors don't fight to change the world. You have proven that doctors are not too tired, too cynical, too focused on pocketbook issues to care about what's happening to their communities. You have won battles across the country that have gotten people the care they need.

Change doesn't happen all at once with proclamations of the powerful. It happens one email, one tweet, one conversation, one letter, one op-ed, one interview, one moment of bravery at a time. And that is the story of Doctors for America - of doctors, medical students, and supporters across the country who have built this movement together.

We have a lot of work ahead of us to create the change we all want to see in the world around us. We have learned so much from this campaign that will make us stronger and more powerful in the coming years as we keep speaking up for the health of our patients and our communities.

But for today, I want to say from the bottom of my heart: THANK YOU. Thank you for all you've done to make this day possible. And most of all, thank you for believing that your voice can make a difference. Because it has.

 

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Thankful for Coverage

By Dr. Katherine Scheirman
.

As you gather with your friends and family this Thanksgiving, there is no better time to reflect on the millions of Americans finally getting the coverage they need and deserve and to help spread the word to the millions more eligible for new coverage during this open enrollment period.

Last year, a friend, who had previously been unable to afford health insurance due to pre-existing conditions, was finally able to get it through the ACA marketplace. He raises cattle here in Oklahoma, so he had no access to employer-based insurance. For the first time, he does not live in constant fear of losing everything due to medical bills. He finally has peace of mind and financial security, and even the ability to get all his prescription medications filled every month. That's a lot to be thankful for, and he is.

This Thanksgiving help a patient, neighbor or friend get covered. This season's open enrollment period closes February 15, 2015, but if Americans would like coverage to start January 1, 2015 then they must enroll by December 15. Help spread the word over the holidays about the importance of getting and staying covered. There is no better gift than the gift of health.

Will you spread the word about open enrollment for coverage in 2015? Together, we will help open the doors to coverage for millions. 

Wishing you and yours a happy Thanksgiving!

Dr. Katherine Scheirman is the Oklahoma State Director of Doctors for America and a retired US Air Force Colonel.

 

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Get the Facts About Antibiotics

By David Berman, DO MS FAAP
.

At this point in time, you are probably being bombarded by the media with Ebola and Enterovirus D68! However, a much greater problem in the United States has been the inappropriate use of antibiotics, the development of antimicrobial resistance and adverse events from antimicrobial therapy, including Clostridium difficile –associated diarrhea.

The week of November 17-21, 2014 is the Centers for Disease Control and Prevention's Get Smart About Antibiotics Week. This is an annual event to raise awareness of antibiotic resistance and to educate about the appropriate and safe use of antimicrobial therapy.

For this event, the CDC works closely with many partners, including the SHARPS Collaborative (Sharing Antimicrobial Reports for Pediatric Stewardship). The SHARPS Collaborative is a working group of 24 free-standing US Children’s Hospitals.

Here are some facts that you can use to educate other physician colleagues and patients:

-Institute of Medicine and the CDC have recognized that antimicrobial resistance is a key threat to the health of the citizens of the United States

-Up to 70% of United States antibiotics are provided to animals that are not sick

-Antibiotics are the 2nd most commonly used class of drugs and prescribing is highest for pediatrics

-In pediatrics, adverse reactions to antibiotics result in frequent emergency room visits, more than any other prescribed medication in children

-More than half of antibiotics prescribed in the outpatient setting are unnecessary (antibiotics being prescribed for common viral respiratory illness)

-More than half of antibiotic prescribing is inappropriate (treatment is not indicated, wrong drug is chosen to target the infection and the duration is too long)

-Thirty to Fifty percent of hospitalized patients will receive antibiotics

-C. difficile is linked to 14,000 deaths each year

-Antimicrobial resistance is on the rise and novel antimicrobial development is on the decline

Please visit the CDC website for more information: 

David Berman works at the​ Division of Pediatric Infectious Diseases at All Children's Hospital, Johns Hopkins Medicine in St. Petersburg, FL.​

 

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Next Steps for Ebola

By Raj Panjabi, MD
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When I was 9 years old, my family left Liberia to escape civil war.  I returned nearly a decade ago to serve the people who are still there through a non-profit I co-founded, Last Mile Health. Today, I write to you from Liberia where the country has been devastated by the Ebola epidemic - an epidemic that touched Americans just weeks ago. We are working hard to build up the local health care workforce and infrastructure to meet the challenges, but we estimate that we need tens of thousands of medical volunteers from the developed world to curb the epidemic.
 
While Doctors for America's mission is to improve health care in the U.S., we have seen all too well in the past few weeks that Americans are connected to what is happening here in West Africa.

As a passionate community of doctors, medical students, and friends, I wanted to make you aware of some opportunities and roles to continue the fight against Ebola

This is the worst Ebola epidemic in history, and it continues to plague West Africa. You can help bring the epidemic under control abroad and protect everyone in the U.S. by getting involved. USAID and the CDC are looking for volunteers, and have also opened platforms for healthcare workers to provide assistance with innovation and education.

Four Ways You Can Help:

  1. SIGN UP TO VOLUNTEER. Learn how to become a medical volunteer in West Africa through USAIDLast Mile Health or Partners In Health.
  2. SUBMIT YOUR IDEAS for USAID’s Challenge Competition to fund and test innovations for PPE, infection treatment and control.
  3. SIGN UP TO BE AN INSTRUCTOR for the CDC Safety Training Courses taking place in Alabama for healthcare workers going to volunteer in West Africa.
  4. SHARE THIS with your networks: Ebola 101 – CDC Slides for U.S. Healthcare Workers

 

 Raj Panjabi is a former DFA Board member and co-founder of Last Mile Health, an organization based in Boston and Liberia.

 

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Enrollment starts tomorrow

By Dr. Katherine Scheirman
.

Open Enrollment for 2015 begins tomorrow and runs through February 15, 2015.

It’s hard to believe that it has been one year since Americans began enrolling in the Health Insurance Marketplace. Since that time, 7.3 million enrollees have signed up for marketplace plans and another 8 million have gained coverage through Medicaid or CHIP.

We have made tremendous progress already. And, tomorrow, with your help, we can continue making progress to ensure every American finally has access to the healthcare they need and deserve.

To kick start your efforts, I wanted to share some DFA tools that have been vital in my advocacy and will serve as the basis for DFA’s enrollment and education campaign:

  • Doctors for America Enrollment 101 PowerPoint Presentation  To help aid your education and outreach, this slide show presentation offers an ACA overview about the benefits available during open enrollment. Use elements of this for your outreach presentations to best suit your audience.
     
  • Pocket card – If you are looking for a handy ACA pocket reference card to slip into your white coat, we have the perfect thing for you. Learn how to screen patients for health insurance, answer basic questions, and point them in the right direction. Print out the pocket reference card and share it with your patients! 

Last but certainly not least,  don’t forget to tell your friends and family to get covered if they aren't already! They can also check out their new options if they got covered in the last enrollment period. For more info visit www.healthcare.gov.

Dr. Katherine Scheirman is the Oklahoma State Director of Doctors for America and a retired US Air Force Colonel.

 

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Get the facts on Ebola

By Dr. Anna Tran
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By now you have heard the news. A third person has been diagnosed with Ebola here in Dallas. News of the virus has consumed the headlines recently -- not only here in Texas but across the country.

People are understandably concerned and seeking information to protect themselves and their families. Many healthcare providers also have questions about how to properly deal with Ebola in their hospitals and clinics. To calm fears and dispel misinformation, I want to share the information available to providers.

Get the facts on Ebola. Four things you can do today:

  • Get up to speed on the basics:
    • Symptoms consistent with Ebola
      • Fever
      • Headache, muscle aches, abdominal pain, vomiting, diarrhea
    • Epidemiology
      • People are not infectious until they develop symptoms.
      • The time interval from infection to onset of symptoms is 2 to 21 days.
      • Two suggested questions to ask a patient for whom you suspect Ebola:
        • Have you been to West or Central African countries, in particular Sierra Leone, Guinea or Liberia, within the past three weeks?
        • Have you been in contact with blood or any body fluids of someone known or suspected to have Ebola within the past three weeks?
  • Review this CDC algorithm on triaging patients with suspected Ebola. For more in- depth information, you can use this CDC checklist.
  • If you have more questions, find your local health department on this searchable map.
  • Ask your local or state medical society to share this information as well.

The most important thing we can do to care for our patients and communities is to stay informed and make sure others are informed, too. Visit the CDC’s Ebola website to stay up-to-date on the latest information for healthcare workers.

Dr. Tran is a Medicine- Pediatric hospitalist in the Dallas- Fort Worth area and the State Director for Doctors for America.

 

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