Chapter 08: Working with LBJ Hospital and Indigent Care
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Description
In this chapter, Dr. Freedman talks about the Lyndon Baines Johnson Hospital in Houston, a public county hospital that has many MD Anderson faculty who work part or full time. Dr. Freedman has worked with the gynecological oncology resident training program since his retirement: a choice he made to continue seeing patients, which he felt he could not do at MD Anderson under conditions where patients required continuous monitoring. He notes the economic burden that indigent patients represented for MD Anderson in the past; he has also had an opportunity to note how many more women physicians are in the field.
Identifier
FreedmanR_02_20120301_C08
Publication Date
3-1-2012
City
Houston, Texas
Interview Session
Topics Covered
The Interview Subject's Story - Post-Retirement Activities; Post Retirement Activities; Professional Values, Ethics, Purpose; Beyond the Institution; The History of Health Care, Patient Care; Business of Research; Fiscal Realities in Healthcare
Transcript
Tacey Ann Rosolowski, PhD:
Another activity that you’re taking part in after retirement has been your teaching work at the LBJ Hospital.
Ralph Freedman, MD:
Yeah, that––
Tacey Ann Rosolowski, PhD:
Talk a bit about that.
Ralph Freedman, MD:
Yeah, it’s been fun. We have the program down there. I work in Dr. Ramondetta’s group. Do you know her? Have you met her?
Tacey Ann Rosolowski, PhD:
No, I have not.
Ralph Freedman, MD:
She runs an interesting program down at LBJ, and I think––
Tacey Ann Rosolowski, PhD:
And that’s a public hospital.
Ralph Freedman, MD:
It’s a public county hospital, and I think the person to talk to more about the arrangement between MD Anderson and the county hospital is Lewis Foxhall, because he’s the one in charge of the outreach and the overall program. So basically, we have––essentially, we have a number of people who are faculty at MD Anderson and actually are on the payroll of MD Anderson and who work at LBJ either full-time or part-time and that there are two major departments. One is Gynecologic Oncology, which I work in, and then there’s a General Medical Oncology––lungs, skin, breast, GI and other things, and they’re also down there at LBJ. The gyn-onc is the only surgical specialty that is actually functioning down there, and I have to say Lois Ramondetta’s done a great job. She’s very enthusiastic about taking care of these patients, because there’s not many people who want to go and devote the full amount of time to working in a place where the facilities are perhaps not as good, not as comfortable, with the ivory tower up there, and then you’ve County Hospital down here, and––
Tacey Ann Rosolowski, PhD:
And this is all indigent patients?
Ralph Freedman, MD:
I would say it’s a mix. Obviously, these patients don’t have adequate insurance to get into MD Anderson, so you’ve got a lower socioeconomic stratum. There are also a number of patients who are what we call undocumented, and I don’t know how well the county actually screens those or permits those to come into the system. They’ve got to be paid for by the county, and if you’re interested in going further into that, Lois would probably give you more details about how that’s working out. Of course, with a new––if insurance and a new thing comes about where you expand the Medicaid group, the question that’s being asked is those patients don’t have to stay there. What’ll happen to our county hospitals, and will those patients then be at MD Anderson? I don’t think anybody–– I’m not sure they know the impact, but you’re looking at distribution of resources at that particular point. One of the difficulties that Anderson had that alluded to was when we had––when MD Anderson was carrying the big burden of indigent patients which were not able to pay where they didn’t have means of being remunerated, that the hospital actually had financial––was running into financial difficulties, and that’s when LeMaistre went to Austin and came up with new arrangements. What we have there is basically we’re down there to take care of the patients there. If they need special treatment that they cannot get at County, like radiation, they may get a special pass to allow them to get radiation at Anderson, which happens in some cases, but surgery and everything else, chemotherapy will be done at LBJ. And there are residents from UT Health Science Center––usually one resident at a time. It’s been fun working with them. That’s been interesting to me––because when we were at Anderson, we didn’t come as much into contact with residents––fellows, we had there, but not residents––and everything is changing now. This used to be a male-dominated field, and now I would say seventy-five to eighty percent of the residents are women, and that’s how it is, and––
Tacey Ann Rosolowski, PhD:
Do you notice differences in terms of how––?
Ralph Freedman, MD:
Oh, they do just as great, just as fine as––I mean—they––some of them may be married, have families, so they got to deal with that and deal with a difficult specialty, but somehow they manage to handle that. And they like to learn things. You have almost a one-on-one relationship with the residents there because you’re working next to them in the clinic. They present the cases, and you have the opportunity to do direct teaching. The case of fellows, they are more advanced, so they know a lot more things, and then they want to go in and get the things done that they need to do––certain number of surgeries—they like to be in surgery, of course—and the clinic is down on the priority list. But if they can get the surgery to be an interesting case to do the surgery, that’s where they want to be. Oh, of course, that’s what you’d expect. It’s a surgical field, and also, from time to time, I did courses for them so that they knew when they’re going to do the exams, the resident’s down there. There are groups of residents would come and do the–– I think this is maybe changing now because they’ve got an oncology group now at the Health Science Center, so they’re getting a lot of their teaching directly there.
Tacey Ann Rosolowski, PhD:
Why did you choose to take on this role?
Ralph Freedman, MD:
When I retired, I wanted to––there were certain things I didn’t want to do. I didn’t want to continue surgery because I didn’t feel that I could do it on a part-time basis, but I did want to keep up with the field, and I felt that working at LBJ would provide me with an incentive to see patients and to teach. And also, that potential was helpful to Lois, who had nobody else working down there, so she could basically take off time to do her stuff. It’s worked out very well. I see patients on a Tuesday; she goes on Wednesday. So I think it wasn’t all altruistic. I did want to do it, and I did feel that that would be a good place for me to work and see patients. I didn’t feel that I could continue to see the patients that I had that are at MD Anderson because I wasn’t going to be able to give them complete care—what they had expected in the past. Like if a patient needs to go back to surgery, I wasn’t going to be able to do that anymore, and I think that was a necessary change. I think our–– There are subtle changes, and sometimes not-so-subtle changes, that take place in us as we get older. In terms of surgical practice, they can be kind of critical, and I’ve come to realize this. It may be just a spasm in your hand or something like that, or something else, and especially if you are not involved in surgery on a regular basis, you can’t keep up your skills. Then I think it’s the patient that doesn’t benefit from this. [The recorder is paused.]
Recommended Citation
Freedman, Ralph MD and Rosolowski, Tacey A. PhD, "Chapter 08: Working with LBJ Hospital and Indigent Care" (2012). Interview Chapters. 948.
https://openworks.mdanderson.org/mchv_interviewchapters/948
Conditions Governing Access
Open
