An Escape Fire for Healthcare
I recently watched a film, called “Escape Fire: The Fight to Rescue American Healthcare,” a 2012 documentary about how the priorities in the US healthcare system are focused on increasing revenue, instead of on goals that improve health, like preventive care. Bill Skelton, founder of the Acupuncture Clinic here in Columbia, SC, gave me the film to watch and said he thought that as a Direct Primary Care physician and owner of Noreta Family Medicine, I would appreciate it. As I learned, an “escape fire” is a firefighting technique, used while fighting particularly dangerous wildfires. It is an intentionally set fire, used when there is no other way to escape an approaching wildfire. The purpose is to burn the fuel (aka grass) around you so that when the approaching wildfire hits that area, it has no fuel and “skips” over the area where the escape fire had been set. The technique may seem counterintuitive – you set a fire in order to escape a fire, but it has saved lives. I’m sure the idea of an escape fire was initially met with a lot of skepticism and criticism. However, sometimes crazy ideas turn out to be inexpensive, revolutionary, and lifesaving. So how does the escape fire concept apply to healthcare?
The film contends that there are quite a few escape fires in the healthcare system, but we tend to ignore them, in favor of maintaining the status quo, which is a complex, expensive, quick-fix system.
As a family doctor who has worked for a large hospital system in the past, I fully agree with this contention. The film talks about some of the escape fires of healthcare, including non-opioid pain treatments, nutrition programs, strong doctor-patient relationships, among others. Trying to convince healthcare executives that the effort to change the status quo is worth it takes a leap of faith, and a lot of courage and patience.
Early in the film, family physician Dr. Erin Martin, is featured. She is about to leave her job due to mounting financial pressures at her practice. The high number of patient visits she had per day left her unable to take care of each patient to the best of her ability. At one point Dr. Martin says “There has to be a different way of doing things.” A light bulb went on for me as I had the exact same thought about 6 years ago when I began to think about leaving my job in an office owned by a hospital system. I ended up opening Noreta Family Medicine in 2020, a Direct Primary Care (DPC). I would argue that DPC is an escape fire for the larger primary care ecosystem. One study showed that the average primary care visit is 18.9 minutes long. At Noreta Family Medicine, I block 60 minutes per follow up visit. I can tell you first-hand that this has allowed me to develop more trusting relationships with my patients, more time to identify and manage mental health concerns, and learn more about how a person’s lifestyle influences their health. Since we are not signed up with any health insurance companies (We charge patients a monthly fee), we don’t have any pressure from insurance companies or healthcare systems to see an unreasonable number of patients per day.
At another point in the film, Dr. Andrew Weil, a well-known integrative medicine physician, states that due to short office visit times, many well-intentioned primary care doctors are forced to prescribe medications, instead of talking about treatments which have fewer side effects, such as nutrition changes. The first barrier to integrating nutrition education into a visit is that like many of my physician colleagues, I was taught next to nothing about nutrition in medical school. Almost everything I have learned about nutrition has come from my residency training onward. The second barrier is that talking to patients about nutrition takes time! Each person comes with a different level of cooking experience and knowledge of food. Even at Noreta Family Medicine, I’ve learned that 60-minute visits are often not long enough! It would be very helpful to have more of a national focus on nutrition to help patients make better choices between office visits. A third barrier is that insurance companies often do not pay for nutrition counseling. Since we don’t have any insurance company payments to worry about at Noreta, we can spend time talking about nutrition!
One final scene of the film that I have to mention features an uninsured patient who stopped taking his medicine due to cost and ended up being hospitalized with significant heart problems. As a primary care doctor who has worked in a free clinic in the past, I very much sympathized with this patient. I wish this patient had known about Direct Primary Care at that time. He would have been seen even though he lacked insurance and he most likely would have been able to afford his medicine at a DPC office despite his lack of insurance. This again illustrates how DPC is an escape fire.
I now know why Bill Skelton gave me this film. Both he and I are providing care for patients using escape fires – I have a Direct Primary Care office and he has an acupuncture office. While acupuncture is mentioned directly in the film, DPC is a concept that was just coming into its own around the time that this film was made and was not well known. However, I’m sure that DPC would have been featured in this film, and I have a feeling Dr. Martin would have made the leap to DPC in a heartbeat!
Have a good week! Feel free to contact me with any questions.
Melissa Boylan, MD, FAAFP
Family Physician and Owner of Noreta Family Medicine
