Mehdi Qalbani MD MSPH
Orleans Parish Medical Society Board Member
We serve patients with complex problems, in complicated social situations, with limited resources. In my case, I serve a patient whose diagnoses include: Schizophrenia, Substance Dependence, and Renal Failure requiring Dialysis. On top of this, his day-to-day life is burdened by unstable housing, transportation challenges, food instability, exposure to violence, and poverty. Despite these impediments, he has improved his life and gained a level of stability that seemed unlikely when we first started working together. Some things fell in his favor. He worked with a medical/renal team that understood his psychiatric symptoms and coordinated care. He was referred to the FACT (Forensic Assertive Community Treatment Team) team a community-based program that provides intensive case management and mental health treatment to individuals who have a severe mental illness and significant involvement in the corrections system. Mostly, he said yes to the limited opportunities given to him. He accepted his illness and actively participated in treatment for his mental illness and substance dependence. He trusted his renal team and their care plan. He persisted in advocating for his housing with his housing specialist (he has his own apartment) and is adherent to the budget proposed by his counselor. His challenges, though unique are common to the underserved people we treat in communities throughout the Greater New Orleans area.
His case gives me hope but it also irritates me because his success is not typical and it should be. His case and others made me realize that I (we) need to become advocates and we can do it more powerfully as a collective. As health care providers, we must begin by advocating to our legislature and work with our payor sources to bring evidence-based practice models to the complicated health crises facing the Greater New Orleans area.
As my patients’ story illustrates, access to care coupled with coordination and trust can lead to better outcomes. We have evidence-based programs that can reach some of the goals outlined by the Department of Health & Hospitals Healthy 2020 program objectives to increase access to care by providing it in the communities where people live, improve quality of care by coordinating across disciplines, and to achieve better outcomes by allowing the time and opportunity to build the trust necessary for behavioral change.
To the first objective: we can always become better advocates. As I write this the Louisiana Senate has just passed a bill that would provide funding for our safety net health care system, continue funding for substance abuse and mental health programs, and ensure that people remain eligible for Medicaid at current requirements. Hopefully, the Louisiana House follows suit ensuring continued access to vital programs that provide better access and quality while reducing the overall spending on individual care. It is imperative that we stay in contact with our representatives, both individually and through our organizations, should the Louisiana legislature resist support for these issues in the future.
To the second objective: we have a great opportunity to improve care for our patients and meet the healthcare needs of our community. Though beds for substance abuse and mental illness remain below recommended standards, we have a robust network of Federally Qualified Health Centers (FQHC) that continue to improve access to care for the underserved. According to the Data Center, there are now 12 FQHCs with over 40 locations throughout the Greater New Orleans Area where our colleagues in primary care treat most of the patients with depression, anxiety, substance dependence, and other common psychiatric disorders with impact on physical and social health.
In surveys related to primary care physician burnout, the lack of time available to care for patients with medical and psychiatrically complex problems is an increasing stress factor for physicians. To relieve this strain on our healthcare system, we should consider implementing coordinated care models which take a team-based approach and incorporate telemedicine. We should also consider expanding the use of peer counselors and technology to improve health outcomes. Ultimately, we must continue to listen and work with our payors to create an infrastructure where these models are tested and ultimately sustainable.
In Greater New Orleans Area and throughout Louisiana, we must continue to make progress in developing solutions to solve big problems such as the opioid crisis, care for mental illness, smoking cessation, obesity and others by incorporating evidence-based, innovative practice models. The FACT program is one example that incorporates care in the community. NAMI (National Alliance for Mental Illness) New Orleans’ program of integrating peer counselors and consumers in direct care are innovative, evidenced based, and cost effective. In addition, Community Psychiatric Support and Treatment teams, psychosocial rehabilitation, substance abuse programs, and drop-in centers all work in concert to meet the complex mental health needs of the Greater New Orleans Area.
With all of these models, the foundation for adequate mental health in the Greater New Orleans Area remains the shared trust between patient and providers. If we, as physicians, don’t have the time or an environment where patients can tell us their concerns, we will experience poor outcomes. The relationship with the patient that I described in the first paragraph took several years to develop. It took time for him to understand that we were there for him. I see colleagues in all disciplines demonstrating this every day. As medical professionals, we must remain vigilant advocates for the privilege of providing this trusted physician-patient relationship.
I am hopeful for our city and our region. In order to have this hope, our patients need to have access. In order to have access, our programs need funding. To get funding, we as a community must advocate beyond our offices.
OPMS and JPMS advocate for physicians and their patients:
Orleans Parish Medical Society (OPMS) and Jefferson Parish Medical Society (JPMS) help serve as a voice for the medical profession in the Greater New Orleans Area. Both organizations play important roles in advocating for physicians, their patients and for improving the overall health of the region. The recent partnership and commitment to collaborative efforts between the two societies make this voice even stronger.
In the medical practice environment, OPMS and JPMS have advocated for significant legislative and regulatory reform at the state and national levels to help physicians address challenges that have come with third-party insurance and governments mandates that make it difficult for patients to receive quality healthcare. Their impact has also been felt in the public health arena, as leaders in the smoking cessation and tobacco control movement, and EMS protocol development and oversight. Recently, they have advocated for adequate state funding for vital health programs and for the future funding for University Medical Center New Orleans.
Both organizations invite physicians, residents and medical students from throughout the Greater New Orleans Area to join in their missions of improving healthcare for the region. For more information about Orleans Parish Medical Society and Jefferson Parish Medical Society, follow their updates on social media (LinkedIn, Facebook and Twitter) and visit their websites: www.opms.org and www.jpms.org.