This project was rough from the start. The multi-media aspect really threw us for a loop, because it’s something none of us have ever done before, and we didn’t  get a whole lot of instruction on how to do it. It often felt like we had been blindfolded and left in the woods to feel our way home. It was definitely frustrating.

The final product is not what we had hoped it would be… but, it is the best we could have done, given what we had to work with and the training we received.  I suppose we should just remember that 85% of good journalism is sheer luck… and it just so happened that we didn’t have good luck this time around. Our audio is strong, and I think our writing is strong… but our visuals are not.

With more training, and more time, we could put together a really strong package. But we did our best, and that’s what counts right now. We are, after all, still students – even if this is the “final” class for most of us. Hopefully, the other groups had better luck than we did.

Zach:

Well, this final project has been one big learning experience…and a bit of a pain. The interviewing wasn’t too bad. I had a bit of a rough start, but was able to pick it up after receiving some good advice from class and our guest speakers. Overall, I feel that we put together a strong written portion.

The multimedia project was another story…

I wish that we had had more time and training on Final Cut. We did the best we could with what we had been given; however, I believe that if we had had more time with the program and more training, then we could have put together a much stronger show. I don’t believe, though, that we did too bad of a job for the amount of training/time that we received.

It was also hard juggling everything going on right now and doing so much work. Everybody in the group was preparing for the end of the semester, working, and taking a full load. The amount of work with the final project seemed too overwhelming, but we got it done and (as I’ve mentioned) I think we did a pretty good job.

Christine:

Wow, this project was an adventure, to say the least. I agree with both Sam and Zach that our written portion was well done, but the multi-media aspect was lacking. Some of the audio we had, that we felt told the story for the people we interviewed, didn’t lend itself to obvious pictures. Video may have been a better course of action for us, but we also didn’t want to do what every other group was doing.

I think that, for future students, a multi-media class should be required – or at least several weeks within the capstone class – if the proect is going to require a multi-media aspect. The journalism program, as it sits, has no standard class for multi-media, therefore most students don’t have the skills to create workable multi-media components to a project.

On the whole, the project was frustrating, but I am fairly satisfied with the work that we did; we each spent five to 10 hours doing individual interviews, research, and writing, and we put in about 17 hours of work on the slideshow.

My average Sunday starts with a cup of coffee, a newspaper and a cozy spot on the couch in the morning sunlight. But on a particular Sunday in mid-October, I spent my Sunday morning (and afternoon) at Flagstaff’s Walk-In Medical Care (WIMC).

My partner had woken up with the symptoms of a sinus infection, and he needed a doctor’s note in order to get the day off of work. We chose WIMC because it was open, it was close to our apartment, and an appointment was not required. WIMC opened at 10 a.m., and we arrived just six minutes after. We signed in and managed to find a couple of seats at the back of the waiting room, which was already close to full capacity. A football game was playing on the lobby television and it provided the only noise in the room, save for the occasional sneeze, cough, or blow of the nose.

After sitting in the uncomfortable chairs for almost 2 hours, the receptionist finally called us up to fill out some paperwork.  Once we had filled everything out and paid the $15 co-pay required by his insurance company, we asked how much longer we would have to wait. The receptionist, Jessica Giffin, responded, “I honestly don’t know. It could be thirty minutes, it could be two hours. We just ask that you please have patience. We’re working as fast as we can.”

With that, we sat back down. And we waited for another 2 hours. In that time, only 3 patients were seen by the physician – a woman with 3 young children, an elderly couple, and a middle-aged man. Two women came in, wearing paper masks, to ask about the H1N1 vaccine. Both were turned away, as they were not eligible under current vaccination restrictions.

It was then that I noticed the sign posted at the reception desk. The sign read, “If your symptoms include a high fever or cough, please ask for a paper mask and sanitize your hands before signing in. Thank you.”

One little boy kept running up to the dispenser and squeezing as much of the antibacterial foam into his hand as he could hold, before blowing on it and sending bubbles everywhere. Each time, he’d let out a deep chuckle and dimples would crease his cheeks as he grinned from ear to ear. His mother was not happy with him, but he provided the only comical relief in the unnervingly quiet waiting room.

After what seemed like forever, and after watching the receptionist replace box after box of the tissue throughout the lobby, my partner was finally called back. The nurse practitioner saw him within 30 minutes, but he was left to wait for the doctor for another hour. When the doctor arrived, he asked a few questions, reviewed the chart, and determined that it was “just a cold.” He scribbled out a note, giving “doctor’s orders” so that my partner could stay home from work and get the sleep he needed to recover. No antibiotics were prescribed, and we were out of the clinic within fifteen minutes of the doctor’s evaluation.

Six hours, one doctor’s note, and no medication – the trip hardly seemed worth it all. It did, however, serve as a strong example of why health care reform is needed now more than ever before.

Dr. Curtis Kommer, a physician on staff at WIMC, had this to say about health care reform and Flagstaff, “It’s a step in the right direction, but we need more than just a step. We need a leap. In the meantime, the staff here at Walk-In Medical will do everything we can to provide the best treatment possible to our patients.”

FLAGSTAFF, Ariz. – With the fate of the entire U.S. health care system hanging in the balance, many doctors have voiced concern, or praise, for the current health care reform bill. But no matter what their stance, many agree that something must be done to bring change to a broken system.

The present bill proposes to make this change by providing affordable medical care to all Americans. This will be done by providing competition in the health care marketplace, placing restrictions on insurance companies, and slowing sharply rising costs.

“In short, the problem is lack of affordable, universal access to medical care,” said Dr. Carl Shrader, who has been practicing medicine in Flagstaff for 43 years.

If the bill is passed by the Senate, and signed by President Obama, then health care would be virtually universal. According to the Congressional Budget Office, the bill would insure 96 percent of Americans.

“If we can spend all this money to drop bombs on other countries,” said Dr. Carroll Wheat, a Phoenix general practitioner, “then why can’t we afford to give everybody health care?”

Dr. Eric Henley of North Country HealthCare in Flagstaff believes that one of the main reasons 45 million are uninsured is because the system has been dominated by specialists, such as cardiologists and pediatricians. The way to reduce costs is to get more doctors to go into general practice, he said.

“We need more family doctors,” Shrader agreed. “Specialists charge high premiums, yet [family doctors] can treat 95 percent of the things they come across.”

This explosion of general practitioners would help reduce wait times at doctors’ offices, which is expected to get worse if the reform passes. In fact, many health care providers in Flagstaff, especially North Country, currently already have difficulty seeing all their patients on a daily basis.

“It’s a chaotic system,” Henley said. “If we get health care reform, the uninsured rate will drop a chunk.”

If this happens, the demand for services will increase, and add tension to an already strained Flagstaff system. That is unless more general practitioners enter the field. Henley said that this access is one of the biggest problems that Flagstaff, and the health care system in general, is plagued with.

Shrader thinks that the government should subsidize medical students’ schooling, as long as the students agree to practice for a minimum of five years as general practitioners. This way, residents of Flagstaff, and the country, would receive the care they need. This would be a similar model to what the military currently does for medical officers.

“Thirteen percent of doctors last year signed up for family doctor positions,” Shrader said.

At this rate, the American Academy of Family Physicians expects a deficit of 40,000 family doctors by 2020. Rural towns, and small cities such as Flagstaff, are expected to be hit the hardest by this shortage.

“Reform will pass,” Henley says, “I’m pretty confident we’ll get something…it won’t be optimal” but it will be something. You have to start somewhere.

FLAGSTAFF, Ariz. – “The U.S., as opposed to all other higher-income countries in the world, has a specialty-dominated healthcare workforce,” said Dr. Eric Henley, Medical Director for North Country Healthcare Clinic. This is one of the reasons why the United States is in such desperate need of reform for the health care system.

“There is some good literature,” said Henley, “that says if you have the right amount of primary care [physicians], as a percentage of the total, it actually is better for costs, [it] lowers costs, and [provides] higher quality.”

Research done by several universities has shown that the changes that could occur with an increase in primary care physicians are substantial. Mortality rates could drop by as much as 10 percent – given an increase of one primary care physician for every 10,000 people. Costs incurred are decreased by one third with an increase in the availability of primary care; and social and economic inequalities are reduced.

Valuing primary care over specialty medicine would not be an easy switch for Americans to make. It would be “very counter-intuitive,” said Henley. “[Americans] usually tend to think that specialty is better.”

Many countries – Japan, most of northern Europe, and even middle-income Asian countries – have approximately 50 percent of their healthcare workforce in primary care.

The United States lags behind. In 2008, just over one third of the physicians working in the United States were in areas of primary care, according to data from the Association of American Medical Colleges.

In Flagstaff, the numbers are much the same. Slightly less than one third of the Flagstaff physicians are in primary care fields, as listed by the 2009 Medical Directory from the Arizona Medical Board.

Making the switch to focusing on primary care in Flagstaff could greatly increase the overall quality of life for residents. The costs of living in Flagstaff are high all around, but decreasing healthcare costs could make a big difference.

The healthcare reform, however, may not provide the answers to the shortage of primary care physicians. Massachusetts implemented a healthcare reform several years ago, but access to primary care has only gotten worse.

With the increase in insured people in Massachusetts, lower-income families who had previously avoided going to see a doctor are now flooding the system. According to an article published by National Public Radio, primary care offices in Massachusetts have a waiting list, some as large as 1,600 patients.

While Flagstaff would see results on a smaller scale, the issues would remain the same; and they would still be unresolved. Considerations should be made to ready the town for any reform that is coming, so that residents of Flagstaff do not suddenly receive less-than-adequate care once legislation is passed.

FLAGSTAFF, Ariz. – According to the National Institute of Mental Health, roughly one in four Americans over the age of 18 suffers from a diagnosable mental disorder. This equates to about 26 percent of the population, or 58 million people.

Due to this staggering number, the health care reform bill has taken action to enact laws that grant employees the same amount of coverage for mental illnesses as for physical ones. This is known as mental health parity.

“The more universal coverage comes, the more mental health care gets parity,” said Dr. Sumner Sydeman, a clinical psychologist and professor at Northern Arizona University.

But how does forcing employers to provide this coverage to their employees save money?

Well, it’s quite simple, according to Disability Rights Oregon. Mental illnesses and substance abuse often result in physical health conditions. For instance, hospitalization and observation for attempted suicide would likely cost more than therapy.

With the Mental Health Parity Act, places such as the Northern Arizona Regional Behavioral Health Authority (NARBHA) would be able to help those with this new mental health plan become acquainted with the system. NARBHA offers services that will help a person choose a mental health provider from that person’s provider network.

However, until this act is implemented, many in Flagstaff and around the nation will remain without care.

Congress has pushed back the date that the act will take effect until January 1, 2010. Those in need of mental health insurance don’t have much longer to wait. This act will soon be in place, but that doesn’t mean that all the issues have been worked out. 

“I think it’s going to have a lot of problems,” said Sydeman, “but something has to be done.”

One of the problems the act faces is a major loophole for employers. The act is not mandated, so employers don’t have to provide this coverage to their employees, said the American Psychological Association Practice Organization. Also, the act will not cover the uninsured, or those who work in places with less than 50 employees

Though the Mental Health Parity Act is not perfect, it will be a foundation for the future of mental health care insurance. 

“I think that the current mental health system is just totally broken,” Sydeman said. “I know it’s going to be expensive, but we’ve got the worst health care…and this isn’t going to fix it, but we have to start somewhere.”

FLAGSTAFF, Ariz. – As the hub of Northern Arizona, Flagstaff’s medical community has been implementing telemedicine practices over the past several years that allow doctors to better serve their patients. Medicine has been merging with technology for more than 40 years, and both of Flagstaff’s largest medical centers now use telemedical tools to make their service of care greater than it has been previously.

“From the research that we’ve done,” said Greg Hales, Program Coordinator for the Telehealth division at North Country Healthcare in Flagstaff, “there aren’t a whole lot of organizations around this country providing primary care via telehealth.”

In fact, Hales said, the United States is drastically behind the rest of the world in providing electronic primary care, even though we are in the lead for other types of telemedical practices.

Telemedicine, which is interchangeable with telehealth, Hales explained, can be separated into two categories: real-time video conferencing and store-and-forward practices.

Real-time conferencing is what it sounds like: a doctor sits at his or her computer with a webcam and the patient sits in an examination room along with a support staff member – generally a nurse – that also has a webcam. Both rooms have screens to allow each party to see the other. In this type of telemedicine the doctor is seeing patients at the time they are in the clinic or hospital, even though the physician may be many miles away, and is able to conduct a normal exam with the help of the support staff.

Store-and-forward type telemedicine is the practice of capturing pictures of the patient, specifically the part of the patient for which he or she is being seen, and sending them to the appropriate physician who looks at them and makes a diagnosis based on the photographs. “[Store-and-forward telemedicine] is about 90 percent of the telemedicine that’s actually done,” said Hales. “And most telemedicine is for the purpose of specialist consultation.”

North Country Healthcare (NCHC), Flagstaff’s largest primary care provider, has deployed the former of the two types of telemedicine within the past six months at each of their 11 satellite sites across Arizona.

Originally they had planned for a telehealth program to help with the administrative duties of keeping the sites in touch and on the same track, as well as providing the medical staff with continuing education. When Dr. Eric Henley became NCHC’s new Medical Director, he decided to also utilize the telemedicine technology to provide services to the satellite sites where physician retention, and making services available to patients, is difficult.

Flagstaff Medical Center (FMC) is Flagstaff’s other largest health provider; its main role is hospital and emergency room. The hospital has been using telemedicine for several years, mainly as a way to get specialist opinions on radiology images.

“FMC is contracted with Northern Arizona Radiology [a local radiology practice] to read and interpret [FMC’s] radiology images,” said John Chadwick, IT consultant for the radiologists.

The teleradiology industry has produced several after-hours teleradiology programs to help medical relationships, such as the one that FMC and NAR have, function even when a radiologist is not right there in the office. Alta Vista Radiology, an after-hours teleradiology reading service, is the program FMC and NAR use, said Chadwick. This program allows the radiologists at NAR to consult on cases and provide second opinions to the doctors at the hospital. This, in turn, helps increase the accuracy of diagnoses and subsequent patient treatments.

Telemedicine holds benefits for both patients and doctors. According to the American Telemedicine Associate (ATA), the top three benefits of telemedicine are improved access, reduced costs and increased patient demand for services. With telemedicine tools, physicians are able to: reach more patients because distance is no longer a factor; lower medical costs, specifically travel costs, for both doctors and patients; and see more patients because of the previous two benefits.

It started with some minor dizzy spells. Then her arm started to fade in and out of numbness. And then she began forgetting the little things, like where she left her cell phone. Deanna Popielarczyk, 21, a junior at Northern Arizona University, was understandably concerned. When she asked a friend to drive her to the Emergency Room at Flagstaff Medical Center, she thought she was finally going to get an answer, and a treatment. What she got instead was a day wasted in the ER. She left with more questions than answers, and had only reaffirmed her belief that she was a part of a broken system.

Popielarczyk arrived at FMC early in the morning, spent several hours in the waiting room, and several hours more in the bed the nurse assigned to her. When the doctor finally arrived, he was kind, polite and confident. But as the day wore on, it became clear that he could not find a reason for her symptoms. After spending six hours behind the curtain of her bed, the doctor announced that she would need an MRI. Unfortunately, Ms. Popielarczyk was a member of AHCCCS, the Arizona Health Care Cost Containment System, and in order for her to receive the MRI, AHCCCS would have to review her file and refer to the “appropriate physician.”

Having dealt with AHCCCS for the last 4 years, Ms. Popielarczyk was used to this, and accepted it grudgingly. She contacted AHCCCS as soon as she got home from the hospital. “I just wanted to get the ball rolling. I know these things can take time, and I was worried that whatever was wrong with me was something that couldn’t wait,” she says.

AHCCCS told her they would contact her within 6 weeks with all of the information she needed to take care of the MRI. But almost five months have passed and she still has not heard from AHCCCS. Some of the symptoms have subsided, some have weakened, but the forgetfulness has gotten progressively worse. “If I thought it would do any good, I would call them. Sure. I’d call and harass them and get answers. But it wouldn’t do any good. Besides,” she laughs, “my memory is only getting worse, so by the time I remembered to call them, the office would be closed and I’d have to leave a message… a message that they would probably never return.”

AHCCCS is Arizona’s Medicaid program. According to their website, they are “Arizona’s Medicaid agency that offers health care programs to serve Arizona residents. Individuals must meet certain income and other requirements to obtain services,” and they “[oversee] contracted health plans in the delivery of health care to individuals and families who qualify for Medicaid and other medical assistance programs.”

AHCCCS may pledge to provide quality health care to those in need, but recent budget cuts may be responsible for the lack of care many have received, including Ms. Popielarczyk. A reduction in the state budget has forced AHCCCS to cut their costs drastically. Ms. Popielarczyk says it best: “Maybe they just can’t afford to provide health care for everyone in need. Maybe they can only afford to provide care for the people who ‘need it most.’ And maybe I’m just not one of those people. I mean, I’m young and I’m not in terrible health. If you have to take a risk with a patient, you’re going to take that risk with me, rather than with some overweight, diabetic 45-year-old with pneumonia.”

In order to maintain her membership with AHCCCS, Ms. Popielarczyk must reapply every 3 months. She has to fight them to cover every doctor’s trip and every prescription. “Nothing about AHCCCS has ever been easy. But it’s free. I might have to fight for it, but when I finally manage to get it, everything is covered. Everything is paid for. And realistically, it’s my only option,” she says.

FLAGSTAFF, Ariz. – With general practitioners hogging the spotlight in the current health care reform bill, it would seem as though others in the health professions have fallen by the wayside. If we are to truly become one nation with health care for all, then we shouldn’t brush off our oral health.

Unfortunately, this is something that many have done, according to Dr. Carter Hagerman, a Flagstaff dentist. Due to high costs and limited availability of dental health plans, many Americans have remained uninsured. A 2004 estimate by the Center for Disease Control and Prevention’s National Center for Health Statistics calculated that more than 100 million Americans are without dental insurance.

“You can’t buy [dental insurance] as an individual,” said Dr. Richard Shannon, also a Flagstaff dentist. “You can only buy it through a group. Well, for the most part. Individuals can buy some of these really second- and third-rate policies, but they hardly make economic sense as an individual.”

With nearly a third of the U.S. population lacking dental insurance, many diseases such as leukemia, anemia, and Crohn’s disease go unnoticed until it’s too late. These are just a few of the diseases that exhibit oral symptoms that can be detected during an annual oral exam. Because many diseases have oral manifestations, the American Dental Association has stated that oral health is a crucial component in the general health and well-being of all individuals.

In the next year alone, 35,000 people will be diagnosed with oral cancer, which is as common as leukemia, and claims more lives annually than melanoma or cervical cancer. Of these 35,000, nearly 8,000 will die, or about one person per hour. If more individuals had access to dental insurance, these numbers should begin to decline.

With the current health care bill, congress has proposed to provide coverage to those 21 and younger, and reduced rates to others.  Hagerman said that if the government is going to take over dentistry as it is medicine, then fees are going to be cut in order to provide coverage to this population.

“Our fees can be cut by 10 to 15 percent and we’d be OK,” said Hagerman. “But if [the government] cuts them 40 to 50 percent, then that’s our overhead. We’re not making any money, so we’re forced to cut costs somewhere else like materials, and cheaper labor, and the quality of work is going to go down significantly.”

If costs are sacrificed, then dentists will have to start getting their materials from places such as China, where products are cheap and quality is subpar compared to the U.S.

Shannon refers to this cost cutting as “mismanaged care.” According to him, mismanaged care occurs when costs are reduced and quality decreases instead of increases, as it is intended to do with managed care. When costs and quality decrease, Shannon believes that patient care and patient-provider relationships are negatively impacted.

“When patient care suffers, relationships suffer,” said Shannon. “Quality of care and compassion are what matter.”

FLAGSTAFF, Ariz. – Tort reform has been hotly debated in the current health care reform issue, but what exactly is it?

Tort reform allows a patient to sue his or her doctor for wrongdoing. However, there are restrictions on what the doctor can be sued for, and how much money the person can win in a lawsuit.

But watch out. This will most likely cost you more money at your next appointment. If your doctor expects something is wrong, then he or she will run more tests than necessary to save face from malpractice and avoid a messy lawsuit. 

This has come to be known as “defensive medicine,” as the doctor is not just diagnosing the patient, but also defending against malpractice liability.

“We really need [tighter restrictions on] tort reform,” said Dr. Carl Shrader of the Flagstaff Concentra Urgent Care. “I used to deliver babies, and was paying $200,000 a year in malpractice insurance. I gave it up because I was paying more in insurance than I was making.”

Connie Hsu, a Phoenix allergist agrees. She said that she would like to reform the current malpractice rewarding system if she could. The reform might reduce costs for patients, but that doesn’t necessarily mean malpractice insurance will be cheaper for doctors. So they’ll keep running unnecessary tests, and costing you more in the long run.

“You don’t get rich being a family doctor,” said Shrader. The practice of defensive medicine not only hurts the doctor financially, but it hurts the patient as well.