Q&A with Glenn Lopez, MD, MPH, Physician at Providence Mobile Health Clinic in Los Angeles, California
Glenn Lopez is a family practitioner specializing in community medicine. Dr. Lopez received his undergraduate degree from the University of Tennessee and went on to attend Cornell University Medical College. He completed his family medicine residency at Cook County Hospital and was awarded a community medicine fellowship at UCLA. There, he also received his executive master's degree in Health Services Administration. In 2009, Dr. Lopez started the Providence Mobile Clinic to provide chronic disease management services to uninsured adults within low-income communities in the San Fernando Valley of Los Angeles (SFV).
Q: What motivated you to become a physician?
A: This question is difficult to answer, but a confluence of factors throughout my life led to my work as a physician.
I grew up in Guatemala, and one of my closest friends was the son of an American physician who set up a rural community development program in Guatemala. I spent weekends with my friend learning about the program, which has become a model for third-world community development.
In many ways, medicine was all around me. My mother was a spiritual person who volunteered at a local Guatemalan hospital, and I always had a liking for biology and social science. What I've always liked about medicine is that it bridges the academic practice of biology and the more social or human side of life. Becoming a physician allowed me to combine what I learned in watching my mother with my personal interest of helping underserved people.
As an undergrad student, I was able to devise my own major. The course I set for myself was one-third focused on nutrition, one-third on cultural anthropology and one-third on development economics. All three areas have a direct connection to the work I do today.
Q: Can you describe the clinic where you work?
A: I operate a mobile clinic serving 12 low-income communities in the San Fernando Valley area of Los Angeles, California. It's a 34-foot trailer where people can sit and support each other in a group environment while I pull patients for their 20-minute, primary care appointments.
Q: When and how did you start your mobile clinic?
A: I set up a medical corporation specializing in on-site care using a mobile model of healthcare delivery. I'm currently planning to do the same within other industries, especially that employ more than 50 workers.
Q: What type of patients/diagnoses do you encounter most frequently?
A: The Providence Mobile Clinic's current model is, in essence, mobile chronic disease management for uninsured adults, so I see a lot of adults battling diabetes, hypertension, asthma, depression and anxiety. We focus on treating adults over 18 years of age, as many of our patients don't have other options for care because they may not only be uninsured, but undocumented as well.
The ongoing support group provides a unique and personal touch to the mobile clinic. We believe everyone deserves quality healthcare, whether or not one has insurance.
Q: What do you like most about treating patients?
A: I love what I do because everyone's story is unique and everyone is fascinating. Even the simplest things can be turn out to be very complex.
Mrs. Rodriguez mirrors many of my typical patients. She is in her 50s, overweight and has diabetes, hypertension and elevated cholesterol. She's also uninsured. Mrs. Rodriguez used to go to emergency rooms for care because she cannot afford private medicine. Once her initial prescription ran out, like many of my patients, she would wait until symptoms re-emerged and then returned to the ER again.
In the ER, patients are often evaluated and stabilized then given a month's worth of medication along with a list of clinics. Unfortunately, a lot of these clinics are closed or have a six-month wait. When patients end up back in the emergency room, it's bad not only for the patient, but for the hospital because they're providing uncompensated care. The hospitals attempt to recuperate their losses by charging inflated fees to insured patients, and the insurance companies in turn pass those costs back to consumers.
It's so important to treat chronic conditions when patients haven't entered this cycle as many people become demoralized and depressed when made to deal with the circumstances associated with uninsured healthcare. Being able to help those people at an earlier stage is very motivating to me.
Q: Are you currently involved with any research projects with the clinic?
A: Yes. Because of the lack of access to low-cost chronic disease management services, hospitals across the country are facing ever-increasing uncompensated ER and hospitalization costs. In starting and managing the mobile clinic, I wanted to show how a resource like this could make a difference.
My work is supported by both Providence Health & Services and the Health Net Foundation. I document the success of the clinic in annual reports with data showing how we reduce the number of uncompensated ER visits in the area we serve.
Q: Do you feel that the role of physicians has changed over recent years?
A: Yes, like many other professional areas, the technology has advanced dramatically. For physicians, many of these advancements have provided new ways of detecting and treating diseases. But unlike other professions, our primary role—to care for patients—hasn't changed at all. The mere fact that I can provide a wide variety of primary care services out of a mobile clinic speaks to this advancement.
We still need to spend time directly with our patients, listening to them and responding to them on a personal level. To me, the technologies that offer the most value are the ones that support me in my primary role of interacting with and caring for patients. I use an affordable electronic health record system, Amazing Charts ( www.amazingcharts.com ), to help me manage my caseload. This has been an effective tool for me because it is easy for my staff and me to use and we haven't had to break our very constrained operational budget in order to bring it into the clinic.
Amazing Charts is also very important because it allows me to prove to my hospital and insurance sponsors that I am making an impact in the community and reducing the load on the ER department. It would be far more burdensome to track this data without this important tracking and reporting tool.
Q: What do you feel is of the greatest concern to physicians today?
A: From my personal experience, I see a lot of physicians who would like to stay in private practice, but cannot afford to do so. Most end up joining a hospital or health network even though they might prefer to work for themselves and have more time with patients. So, I would say a concern of many physicians today is making ends meet while fulfilling their calling to care for patients in a meaningful way.
Q: What is the most rewarding part of operating a mobile general practice?
A: As part of the clinic, we have a large "waiting area." That's where the support group happens. The waiting area is a place where our patients participate in an ongoing conversation about how to better manage their conditions. They learn from each other and support one another.
Facilitating building the sense of community surrounding personal care is incredibly rewarding. Over the course of a couple of meetings, patients undergo a transformation, becoming more self-reliant and engaged. They talk about exercise, diet, and medication and are excited to help others. With our model, the patient is also the healer.
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