Tuesday, October 30, 2012

A Voice for the Voiceless in the Utah State Legislature

Autism Speaks is a national advocacy group representing the tens of thousands of parents across the nation who have children with Autism. Recently, Autism Speaks released a public service announcement highlighting the prevalence of Autism in our society with Tommy Hilfiger – a parent of child with Autism – providing the commentary.

Autism Spectrum Disorder (ASD) is a complex neurobehavioral disorder that affects thousands of Utah pediatric patients.  Nationally, it is estimated that 1 in 88 patients is affected by autism spectrum disorder.  The prevalence is estimated to be even higher in Utah possibly affecting 1 in 47 children.  Why this prevalence is so high is not clear.  What is clear is that autism is even more common than many diseases such as breast cancer or juvenile diabetes.  Autism has devastating effects on the patients physically, behaviorally and intellectually.  It is often associated with other specific disease such as gastrointestinal and lung diseases.  Autism has collateral emotional, physical and financial stress on their families.

As we study autism, we learn about its complex genetic and environmental causes.  There are some studies that suggest that it may be decreased with prenatal vitamin and folate supplements. So far however, we have no single definitive cause and so more medical research still needs to be done.  We have made significant progress in treatment. One effective, evidence based therapy is early diagnosis and early intervention such as Applied Behavior Analysis (ABA) on affected children.  There are clear improvements in those who receive this treatment. 

From a health care standpoint this is effective and high quality care.  From a fiscal standpoint, such prevention just makes sense.  With early intervention patients can have long lasting improvements in social interactions, communication and behavior.  This may avoid very costly long term care or even institutionalization.  Some patients even are able to move off the ASD spectrum with therapy and support.

Utah needs to re-evaluate the current health care insurance definition and coverage of Autism.   Autism is a real disease.  We need to define it.   We need to treat it just like we do other serious, long term afflictions such as diabetes and high blood pressure, for which we know that intervention has long term positive health and financial benefits. 

Parents and families should not have to face bankruptcy or foreclosure just to see that their children receive necessary treatments. We can and must do better as a society.

Previous efforts in the State Legislature have failed to fully address the problems that parents of children with Autism face in ensuring that their children are insured and receive effective treatments. As our next State Senator I will continue the dialogue and further the action surrounding Autism to see that it is fully addressed in the home, the clinic and in the Legislature.

Dr. Brian Shiozawa is a family physician and emergency room doctor who is running for State Senate District 8. He can be reached at (801) 230-3406.

Sunday, October 28, 2012

Reducing the Costs of Defensive Medicine

Defensive medicine costs are a big deal. They add so much in terms of actual dollar amounts to everyone's bills, whether in the clinic or in a hospital setting. Many studies estimate that up to 20-40% or more of our medical bills are inflated by defensive medicine costs. Given the huge costs we face, reduction of these would help reduce medical costs a lot.

Even more, excessive and unnecessary tests are dangerous to patients. For example, an Abdominal CT scan adds up to 30-50 times the radiation exposure of an ordinary x-ray. Imagine the effects this could have on your body in terms of injury. And this is done just because a doctor is in fear of being sued.

Here is one way I propose to reduce defensive medicine costs: I am one of the two physician members on the Lt Gov. Task Force for Medical Liability reform. We are working on a specific plan to help patients and physicians resolve medical injury disputes more quickly and less expensively through face-to face early communication between patients and hospitals and doctors when a suspected medical induced injury occurs. We believe that this new system, already successfully used in Washington and Michigan, will enable resolution with fairer, quicker compensation and preservation of the doctor-patient relationship. This early resolution process is virtually cost-free compared to the traditional tort system that involves formal lawsuits and all of the associated attorney fees. We are going to test this at the Univ. of Utah and hopefully then at IHC and HCA, etc.  This system benefits and makes sense for all parties involved.

Here's another idea: I would like to explore further a "de facto" protocol for medical quality of care as well. This is a system wherein we develop specific evidence-based guidelines for quality of care. In other words, we would develop specific testing protocols for a condition like chest pain. Affected parties of patients, trial attorneys and physicians could review and agree to these ahead of time. These protocols would ensure the high quality care based on the best medical practices. It would maintain quality for patients and reduce unnecessary other unneeded defensive testing.

Reforming healthcare is an important priority for me. It’s a task that will require bipartisan cooperation, with lawmakers from both parties coming together to figure out what is best for Utah. I am confident that I can and will be an effective part of this process and a strong representative of SD 8 residents.

Decreasing Classroom Sizes

As a physician, I realize just how crowded our clinics and ERs can be.  Access to see a physician is very difficult on a same day basis, and so many patients resort to Urgent Care facilities or to the ER at their local/regional hospitals.  This is just not optimal care.  Patients and physicians begin the important health care encounter often as strangers.  Many times previous records are unavailable, and so each encounter literally starts from scratch.  This adds increased expenses as redundant or unnecessary tests are done, it adds risk to the encounter as patients are treated by someone who is unknown to them and important parts of their history may not be known, etc.  Quality of care suffers.

To address this problem, many clinics are adding mid-level providers such as physician assistants and Nurse Practitioners to their health care team.  This effectively expands the number of patients who can be seen each day and improves access and quality of care, as it reduces delays in being seen.

Today, our public school classroom sizes are growing and often overcrowded.  I often hear reports from teachers that their students are literally seated on the floor due to lack of space. Furthermore, we know that each year there are thousands of additional students added to the growing ranks of those currently enrolled.  An additional challenge is the increasing number of students for whom English is a second language.  As a result of the overcrowded classes and increasingly diverse student population, excellence in teaching and quality can suffer. Teachers, no matter how hard-working or dedicated, cannot care for these many students as they would like.  Such frustrating conditions lead to lower scores, teacher burnout and attrition of our best teachers.

One remedy would be to use “mid-level providers” in the classes as well.  We should explore using more teacher’s aides, who could assist the teacher and create a team approach.  The teacher’s aides (TAs) could be specialized in math, reading, art etc.  The TAs could then “functionally” decrease the class size and allow the teacher to focus on those who need particular mentoring.  Quality would improve.  Furthermore, teacher’s aides, both part-time and full-time, could be hired at lower cost than full time teachers and allow education budgets to be stretched more effectively. I have heard many reports that aides are also able to foster a better general atmosphere in the class with better communication, less disruptive behavior and in general a more organized and effective experience for the students and the teachers.

Education quality and funding and large classroom sizes remain at the forefront of our challenges as a State.  It is a challenge that we will need to address this upcoming Legislative session.  This is a realistic, practical solution that we can and should implement soon.

Saturday, October 20, 2012

Civil Political Discourse

The other night, I attended the Murray Chamber of Commerce’s “Meet the Candidates Night”.  It was a great event and a great chance for the various candidates to introduce themselves and their platforms.  One of the questions I was asked had to do with negative campaigning, specifically from the Republican party criticizing two of the incumbent Democratic Representatives.  Both have served multiple terms in the House and are well-respected.  I was asked if this criticism was hypocritical as Senator Hatch has served even longer.

We have all been inundated with negative attack ads, at the national, state, and local levels. I think everyone is fed up with it--and rightly so.  It’s tragic that rather than positively describing our plans for how to improve government and solve the problems we’re dealing with, many politicians focus on perceived negative traits or unsavory past rhetoric of their opponents.  Most of this negativity flows from party affiliation, with Republicans pouncing on opportunities to attack Democrats, and vice versa.  This kind of campaigning distracts us from the big issues such as healthcare reform, jobs and the economy, and improving education. This kind of quarreling is anathema to the bipartisan cooperation that is essential to finding the right solutions to our nation and state’s very serious concerns.  It was immensely satisfying to observe, after months of negative ads from both sides, Pres. Obama and Mitt Romney speaking cordially and graciously to one another at the Al Smith Dinner recently.  They acknowledged each other’s families and individual strengths.  We need more civility, common sense, and respect in our political discourse.  That is the difference between politics and statesmanship.  

Wednesday, October 17, 2012

Thoughts on Public Education

Tonight we enjoyed a nice VoteShiozawa cottage meeting hosted by Gloria Johnson, in Cottonwood Heights.  We had an engaging discussion with many of her neighbors about a number of topics including last night's Presidential debate.  We also discussed public education and some current concerns. These include large classroom sizes and methods to remedy this.  One obvious solution is to hire more teachers.  However, the cost of implementing this fix would be up to tens of millions of dollars and could be cost prohibitive.  Another concept would be to use a "mid-level provider" much like we do in clinics and hospitals.  For example, many physician practices which are very crowded are using physician assistants (PAs) and Nurse practitioners to increase the number of providers and to increase the accessibility of the clinics to patients.  Patients under this plan have a much better chance of being seen on a timely, even same-day basis.  This has the other advantage of keeping many of them out of the very expensive ER setting.

So, consider doing a similar staffing model in the classroom using teachers aides.  Teachers aides could assist the classroom teacher, who could then both teach and supervise.  The individual students would get valuable and personal interaction, despite the large numbers in the classroom.  This concept would effectively reduce the classroom size and increase the face-to-face interaction with the teacher and the aides. Teachers aides would also be much less expensive to hire and could be specialized to teach important topics like reading, math, language, music and the arts, for example. 

We all recognize the importance of good, quality education. We also know that each year, the number of new students in Utah schools increases by 8,000-12,000.  This is both a blessing and a challenge. How can we handle the increase in students, maintain quality and achieve reasonable classroom size?  This concept of aides is one that we can and should pursue more.

Utah's Patient Advocate on the Hill

As many of you know by now, I have been serving our community as an Emergency Department physician for the past 20 years. Each day I have the opportunity to treat those who are sick or injured and work with them to improve their health and get them feeling better. 

As an Emergency Department physician my first and only priority is to help people get better. Each day I treat patients from all walks of life and from all social and economic backgrounds. I have firsthand knowledge and experience of the issues they face – not just with their health, but in trying to afford health care as well. I have seen too many instances where people have put off treatment – only to have their condition worsen – because they have been afraid of how much it would cost them to get better. 

That is why I have been actively engaged the past few years as a Patient Advocate up on Capitol Hill. As a physician, I am committed to helping patients improve their health. As an individual, I am committed to helping all of us receive more affordable healthcare. No one should have to put their health - and their family – in danger because of fear of the costs attributed with treatment. We can do better – we have done better –and we will continue to improve. 

 Recently, I have served as the President of the Utah Medical Association. This past session I worked tirelessly to see laws passed that truly advocated for patients. In fact, the last piece of legislation that was passed protects patients who struggle to pay for medications. 

As a physician, I prescribe medications that help to improve the health of my patients. However, studies show that a large portion of the prescriptions that physicians write are not filled, because patients cannot afford them. Too often, patients are faced with the dilemma of either paying for food or purchasing their prescriptions. This should not be the case! 

This past session I helped to pass legislation that puts patients first. Under our old law, doctors were only allowed to give up to 3 days of samples of medications to patients to improve their health. It was my great pleasure to advocate for patients in seeing the law change so doctors can now give free samples to patients for up to 30 days! Now, patients no longer have to face the difficult position of choosing between food and potentially life-saving medications. I helped to pass legislation that makes healthcare more affordable, saves patients’ money, and has the potential to save lives! 

My pledge to you is that I will continue to be a Patient Advocate on the Hill. All of us have been or will be patients. I will do all I can to ensure that you and I receive affordable healthcare. I have many innovative ideas that I will take to the legislature to improve our health care system. They include: 
• Increasing Patient Accessibility 
• Improving Healthcare Quality 
• Reforming Medical Liability 
• Improving and Reforming Medicaid 
• Lowering Healthcare Costs 

I personally have been blessed to work in the Emergency Department for over twenty years. I am grateful to treat patients, whoever they are, wherever they are from, to work hard and do the very best job I can. As a physician I recognize that I do not know everything but I act with patients' welfare in mind and in good faith. I am grateful to advocate for patients in the Emergency Department and will continue to do so at the State Legislature.

Sunday, October 7, 2012

Passing On

My aunt died this past week.  I just returned from visiting with family who had gathered from afar.  Despite the sadness surrounding her passing, it was great to look at photos and reflect on her life as a daughter, mother, aunt and friend.  We reminisced about her career as a post-WWII Japanese American school teacher in a virtually all-white community.  It was great to talk with and hug cousins and others whom I had not seen for years and in some cases decades.  We re-connected about careers, children and our memories and hopes.  I even met some relatives for the first time.  The gathering was only for a few short hours, but it was great.

Afterwards, I reflected on this event.  I was sad because this is the final time in this life that I will ever see or touch my Aunt.  Frequently, in my job in the ER I treat dying patients and counsel and console their loved ones.  However, that is a more clinical and professional interaction.  This time it was personal.  This time it was me experiencing the separation and loss.  Experiences like this make life real.  This time made me more empathetic and understanding.

It was also a time for me to make some resolutions.  First, I resolved that I would strive to remember what a wonderful blessing it is to have family, no matter who they are, what they do or where they live.  There is something so special about the common ties of being related.  Next, I resolved that I would take time to visit face-to-face more with family.  Not just via social media--though this would be a good start--but actually to take time to visit their homes, open my home or even consider a reunion.  The last reunion with this branch of the family was back in the 80s. This is way too much time away from each other despite the typical excuses of work and our other activities.  Few of those activities which distract me away from family are nearly as memorable or rewarding.  Lastly, I resolve to serve more and to be served.  For example, I learned of physical illness, emotional hurts, and other problems that afflicted many family members of which I had not been aware.  I wish that I could have added what talents I have in helping them.  I did not know about their lives, and they did ask.  There is something that is enriching about serving others and being served by them.  It creates bonds that time can never break.

My aunt is gone.  Her memory remains and the lessons from her life will continue to enrich mine and the lives of my family.

Monday, October 1, 2012

Shout out to Mary Jo Naylor

I'd like to give a big shout out to Mary Jo Naylor for her excellence in teaching. It's because of great teachers like Mary that Utah's children have been given such a great start in life. Our education system depends upon and thrives because of people who do what she does. It's always satisfying when teachers get the recognition they deserve.

 Her frustration with class sizes that are too large is valid. This is something that lawmakers in Utah need to make a priority. The key to making this happen is definitely going to be funding. This is one of my campaign's highest priorities and I expect this will be one of the biggest priorities on Capitol Hill.