Response to Low-Income Patients
By Terundu Ugondo

Laurel Coleman, '84, wanted to be a doctor so that she could serve others in a practical way. She wanted the relative independence of a medical career and the breadth of ways she could use the profession over time.

"I like the possibility of working for myself and having a little more time," she said. "I felt more confirmed by God as I was able to keep going on to the next step, but not without a few bumps in the road."

Even though Coleman didn't get into medical school her first try, she never gave up. She worked for a year and during the same period she got married to her husband, who was already in medical school.

Coleman was accepted the second time and earned her specialty certification in geriatric medicine and hospice and palliative care. After her training, she worked full time for the first 10 years in nursing homes.

"I feel a great privilege when people share their life, their pain, their fears, their private concerns and then I am able to help in a small way," she said.

As an internal-medicine physician, she loves to help others through very stressful times. Even though the rewards are many, advocating for the patients gets harder every day, Coleman said. The greatest challenge in her calling is helping those who do not have health insurance.

For some medical practitioners, the change in health care and the continual cutbacks in the medical field affect the way they relate with their patients. The health-care systems just do not adequately provide for uninsured patients. Health-care providers are concerned that large cuts in Medicaid funding will simply shift the cost of caring for low-income people onto local and state governments and providers in the form of uncompensated care, according to a 2006 RobertWood Johnson Foundation Research.

The growing bureaucracy of medicine is time-consuming and often feels very wasteful, in terms of formularies of drugs, but the profession requires life-long learning, Coleman said.

One of the major bureaucracies stems largely from the fact that health care is a business for which insurance companies try to make money for their stockholders by holding down medical costs. This often conflicts with patients' desire to "do everything" to achieve their health goals, Coleman said.

"We as physicians are often in the middle of this, and need to get approval from insurance companies for tests and procedures," she said.

As a geriatrician, she has been able to use her skills both within and outside the country. Coleman has worked in nursing homes; in a retirement center doing health care; on several boards; and in geriatric consulting for challenging patients. She recently went to an AIDS orphan center in Botswana to explore ways she could help improve palliative care in the country.

Stanley W. Borg, '82, shares Coleman's view of what it takes to be called as a medical practitioner. It means commitment to education, training, service, patients and lifelong learning, Borg said.

"Practicing medicine is the best option for the blending of science, people, helping others, choice of geography for work, and job security," said Borg, the chief medical officer for the Los Angeles County Community Health Plan. He developed a specialized health-care-benefit program for over 100,000 indigent and homeless residents of Los Angeles County. He works to provide affordable health-care plans that meet the needs of employers and families.

Borg is also responsible for medical policies, utilization management, case management and disease management, quality and pharmacy programs at the Blue Cross and Blue Shield of Illinois, the oldest and largest health-insurance company in Illinois.

Although Borg does not practice clinical medicine, he has volunteered to work at a free clinic and has been a part of crafting health policies and improving the quality of health care and access to it in Los Angeles County.

"Health care and/or medicine remain a challenging and rewarding career," he said. As with Coleman, the most challenging part of his calling is providing affordable health care for all patients.

"I remember seeing a man who was diabetic and lived in a shelter. He performed day labor at construction sites and had an infected ulcer on one of his feet. While I could give him antibiotics that day, it was doubtful he would have clean socks to wear daily," Borg said. The man's ability to monitor and control his diabetes was limited to his access to free care and medicines.

Coleman and Borg share the same fears about health care. The extreme cutbacks in the medical field have made it difficult for patients to get the services they need. The Journal of Health Care for the Poor and Underserved reported in 2004 that free clinics nationwide care for a substantial number of the nation's uninsured. These clinics provide health care to at least 3 million Americans.

Despite the help of free clinics, the increasingly high number of uninsured people affects the volume and distribution of emergency-room services used by low- income people, according to the 2006 RobertWood Johnson Foundation Research report.

While Coleman and Borg worry about patient care and the cutbacks in their profession, they still are passionate about their calling.

The most rewarding experience for Borg has been to keep both "health" and "caring" in the business of healthcare. He has educated patients about the health-care system.

For Coleman, the rewards are many: "I can take my skills anywhere and often am able to be helpful in odd places… the AIDS orphan program in Botswana or the soup kitchen in Augusta, Maine," she said.

As a physician, the intimacy she has with another human being has been the greatest reward for her. "It is the most rewarding career that I can imagine."

Coleman and Borg advise students interested in medicine to be aware of how much health care will continue to change. "Since we cannot afford everything, we need to ask how much we want to spend, what our health-care priorities are and how we want to pay for care," Borg said.

"Be realistic about what it will take to pursue medicine, enjoy the process while you can -- even the studying -- or else you will feel like half of your life is gone when you are done," Coleman said.