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VOL. 41 | NO. 26 | Friday, June 30, 2017

Chattanooga physician has big plans for her TMA term

By Nancy Henderson

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Shumaker

Dr. Nita Shumaker is quick to point out that she is by no means a negative person.

Her goals – and there are many – as the new president of the Tennessee Medical Association simply stem from an overwhelming desire to improve the health care system for her colleagues and, ultimately, her patients. She’s got strong opinions on the insurance industry, the opioid epidemic and clean eating.

“It’s hard to be a doctor, and not just [because of] the intensity of being available all the time,” Shumaker says. “Your brain has to always be working in the background. Your bell has to be ready to ring.

“I’ve got to never get so fatigued or so distracted by anything going on in the office or in my life that I can’t laser-focus on that patient in that room in that situation to make sure I don’t miss anything.”

Despite the brevity of her term – she will, like her predecessors at the TMA, serve for one year – Shumaker is determined to make a difference by addressing issues ranging from navigating changes in government regulations to helping the state’s residents get fitter and healthier.

Candid and outspoken, she doesn’t hesitate to speak her mind about the way insurance companies operate.

“The insurance issues are what bug most doctors the most, trying to get approval for things that patients actually need and not being able to,” she explains. “It’s got to be the only industry in the world where you can call up and say, ‘This needs to be done,’ and they say, ‘OK, we’ll pay for it,’ and then 30 days later, say, ‘We changed our mind.’

“Can you imagine going to Walmart and using your credit card, and then the credit card company calls Walmart and says, ‘No, we’re not going to pay for that?’

“I just heard about some cancer doctors who are literally paying the extra 20 percent that insurance doesn’t pay so their patients can get chemotherapy, so they’re losing money.

“That’s not a sustainable model.”

Another big problem for doctors, she adds, is the difficulty of communicating with each other under tight restrictions designed to prevent healthcare fraud, including Title II of the Health Insurance Portability and Accountability Act (HIPAA), which governs electronic transactions and information.

Some physicians’ internet servers aren’t compatible with that of their peers, making it difficult for them to reach out for advice or share details about a patient’s condition. There are regulations governing text messages.

And the implementation of a secure database that allows a patient’s various doctors to view shared information and concur on a treatment plan isn’t happening soon enough, Shumaker says.

Also on her agenda is a major push to educate patients about food sources and encourage healthy eating. Starting with one simple change – drinking water instead of sugary or preservative-laden beverages – can make a big difference, she says.

So, can buying fresh foods rather than boxed.

“The food industry’s doing exactly what the tobacco industry did,” Shumaker asserts. “They are spending billions on marketing, and they are hiring biochemists to try to hit our pleasure centers to addict us to food. And we keep buying.”

One solution, she says, is to levy a tax on foods high in sugar, fructose corn syrup, and other caloric sweeteners, and use the money to offset the cost of fresh produce, making it cheaper to purchase fruits and vegetables and more expensive to buy sodas and power drinks.

“Did you and I have Gatorade growing up?” she asks. “Were we athletes? We were super athletes. We could climb a tree. Most 12-year-olds can’t do a push-up now.”

No matter what happens with Trumpcare vs. Obamacare, she continues, “The underlying message is that we are all much sicker than we have been because of our lifestyle. And until that changes, we’re not going to be able to afford to get health care.

“What most people say is, ‘It’s my individual right. I can do what I want to. Well no, if you’re in a risk pool with me and BlueCross BlueShield, it’s not really your money. You don’t have a right to not wear your seatbelt or smoke or overeat because you’re costing the rest of us.

“I have upset some people talking about this. Unless you’re independently wealthy and you’re paying out of your pocket, we really do have a responsibility to each other to help keep health care costs down by being as healthy as we can.”

Despite her commitment to promoting clean eating, her greatest passion right now lies in curbing the swelling opioid epidemic.

The Tennessee Prescription Safety Act of 2016, designed to enhance the 2002 Controlled Substance Monitoring Database that requires physicians to check a patient’s history of opioid use, only gives access to top known prescribers, not all of them, Shumaker says. The database also omits some pain clinics that may be overprescribing.

Rather than rely on incomplete resources, Shumaker’s goal is to start on the “front end” and help consumers understand just how addictive painkillers like Demerol, Percocet and OxyContin really are – before they get hooked.

One in seven people, she says, become addicted on the first refill, a fact that some doctors aren’t aware of either.

“We have an entire generation of people who have low back pain, and every morning I’ll see an opioid constipation commercial with this healthy-looking guy,” Shumaker explains.

“That pisses me off. It fires me up every morning because we have taught a generation that you manage chronic pain with opioids, and there’s more and more research coming out, saying, ‘no you don’t.’

“You either fix the problem or you do acupuncture and physical therapy or [use] some other way.”

Shumaker is urging other physicians not to prescribe the narcotics unless absolutely necessary.

If they must do so, she asks them to advise patients to take as few pills as possible until the pain lessens and flush the rest down the toilet.

She also wants to give doctors access to the same sophisticated data that pharmaceutical representatives use to find out who’s writing prescriptions.

Shumaker takes issue with the standard pain scale questionnaire that hospitals distribute to patients.

These sheets, which bear “smiley face” icons beside numbers to inquire about a patient’s level of pain, are used by the Centers for Medicare and Medicaid Services to reimburse hospitals based on patient satisfaction scores.

“I’m not supposed to make people happy. I’m supposed to do good medicine,” Shumaker says matter-of-factly.

“They may come in and want something that’s not in their best interest, like a sinus infection antibiotic when they’ve had a stuffy nose for two days. We as a society haven’t merged those two things yet – patient satisfaction and doing what the patient actually needs.”

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