Understanding challenges patients face

Dr. Bussey-Jones and patient Stephen Belcher.
Dr. Bussey-Jones sees the human in me,” says patient Stephen Belcher. Seeing the human in patients—and understanding the challenges they face in their lives—is exactly what Bussey-Jones wants to teach the Emory medical students who spend time in the Primary Care Center at Grady. It’s one of the biggest ambulatory practices in the state, with a substantial number of uninsured patients as well as many with only Medicaid or Medicare.

 

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Stephen Belcher’s lymphoma didn’t kill him, but he has a collection of other diagnoses that could.

The reason they haven’t, he says, is Grady and doctors like Jada Bussey-Jones.

Belcher is a Grady baby (“the real Atlantans,” he jokes), who drove a taxi for 40 years, rising to represent drivers in their dealings with the Atlanta Convention and Visitors Bureau. About 10 years ago, however, the seven-day-a-week, 12-hour-a-day schedule appeared to be catching up with him. He felt exhausted. A series of tests showed stage III lymphoma. After six cycles of chemotherapy at the hospital’s infusion center, he entered and remains in remission.

Then came the difficulties in breathing, the chronic obstructive pulmonary disease, the trips to the emergency room, the implantable device for heart failure, and, most recently, the inflammation related to pulmonary sarcoidosis.

As the diagnoses mounted, so did the number of his specialists. Bussey-Jones, his long-time primary care physician, coordinates Belcher’s care and encourages healthy behaviors. After he completed the nutrition class she recommended, he dropped 30 pounds and got rid of yet another diagnosis: sleep apnea. He sees her every three months but has her phone number if problems arise between visits.

When Belcher first met Bussey-Jones, he was, in his words, one of the working poor. No savings, no insurance. Bussey-Jones says, “At Grady, we have many, many patients like Mr. Belcher. We have to think about their health problems—and the problems they may face in their communities—but thankfully, we don’t have to think about their lack of resources or insurance.”

As a child in rural Georgia, Bussey-Jones watched both her grandparents die of preventable diseases. Neither had ever seen a doctor. She identifies strongly with the indigent, minority, vulnerable, frequently uninsured individuals who make up the majority of the 70,000 patients seen each year at Grady’s Primary Care Center, where she serves as medical director. She also co-directs the Emory Urban Health Initiative, in which medical students learn to think about their patient’s social context and the personal or environmental barriers they face that “often have more to do with outcomes than the 15 to 20 minutes we spend with them as health care providers,” she says.

       
   

Grady patients receive extraordinary care, often in Emory-led programs not widely available elsewhere in the region, including centers for burns, poison control, HIV/AIDS, stroke, cancer, diabetes, and sickle cell disease.

Emory faculty provided $24.8 million in uncompensated care at Grady last year.  When patients do have coverage, all payments for Emory services go to the Emory Medical Care Foundation, which uses this revenue—$43.5 million in fiscal year 2013-2014—to support Emory’s mission at Grady.

 

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