Dr. Kenneth Shine (right), The University of Texas System executive vice chancellor for health affairs, discusses medical health issues with Dr. Abraham Verghese (left) at a gathering of fourth-year Health Science Center medical students.
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Fourth-year medical students at The University of Texas Health Science Center at San Antonio got some advice on how to advocate for better health care from The University of Texas System executive vice chancellor for health affairs.

The executive vice chancellor, Kenneth I. Shine, M.D., has tackled some of the toughest ethical problems in health care, from end-of-life issues to the treatment of AIDS patients in the early 1970s. In a nutshell, he advised the medical students to:

1. Get good medical training, because physicians with good credentials are respected and more likely to be heard.
2. Become involved in advocacy groups.
3. Know and visit your local legislators.
4. When presenting a problem for legislative consideration, always come prepared with a well-thought-out solution that addresses more than caring and compassion, but also the bottom line.

The forum for the presentation was a discussion on campus March 29 with Abraham Verghese, M.D., professor and director of the Health Science Center School of Medicine’s Center for Medical Humanities & Ethics. The topic was “Dialogue: Code Red. What Can I Do About Social Injustice, Patient Underfunding and Health Disparities? Is It My Problem?”

Dr. Shine emphasized to students the importance of caring for patients and becoming an advocate, especially for those who are marginalized by society. He noted that like those in the audience, he once was a young, idealistic medical student whose goal was solely focused on serving patients. However, reality struck home in his third year of medical school when he saw the clash of idealism with the real world. “One thing that bothered me was that when an error or mistake occurred, it always seemed that the most junior person was blamed,” he said.

To Err is Human
He spent the majority of his career trying to help improve the health care system and was president of the Institute of Medicine when its landmark 2000 report, “To Err is Human: Building a Safer Health System,” was published. The report suggested that 44,000 to 100,000 deaths per year occur due to medical errors.

The report noted, however, that the errors were not necessarily due to inept doctors or nurses. They are caused by a system that allows mistakes, many of which are preventable, to happen too easily. The report began a nationwide movement to improve policies and procedures in all areas of health care to help avoid medical mistakes. He cited M.D. Anderson’s “good catch” system that allows anyone to anonymously submit a problem that needs to be addressed.

Code Red
In his new assignment in the UT System, the cardiologist is continuing the quest to improve health care by heading up Code Red, a statewide effort by the 10 major Texas academic health institutions to improve access to health care for the uninsured and underinsured in Texas. An initial report issued by Code Red states that in 2004, one-fourth of Texans were without health insurance, the highest proportion of uninsured individuals in the United States.

As a result of Code Red’s efforts, more than 40 pieces of legislation (www.coderedtexas.org/) are being considered this spring in the Texas Legislature. He said most of them will be addressed in April. Two major issues, he said are providing more high-quality residencies in Texas for medical students and establishing a multicounty regional health system. All too often, he said, counties do not take responsibility for treating low-income patients and send them instead to metropolitan areas. A multicounty approach would help make the cost of health care more manageable.

Take care of yourself
He also urged the students to take care of themselves, both mentally and emotionally. Making time for family is essential, he said, noting that he designated Sundays as family days. Physicians also need to be aware that they will occasionally need some help. “All of us at one time or another will face mental health issues,” he said, due to the work load and the life-and-death decisions physicians must make. “One needs to be able to get help,” he said.