Patient And Environment Care
Interviewed by Melissa Moniz
Wednesday - January 02, 2008
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Dr. Roger Kimura
Internal Medicine
Interviewed by Melissa Moniz
How long have you been practicing?
24 years.
What has been the biggest challenge/change in your profession since you started?
There’s a lot more paperwork that we have to do. The practice has gone from traditional fee for service. In Hawaii, most people have always had insurance and most physicians go through the insurance companies to get payments, but the reimbursement has dropped considerably. A lot of the insurance companies tie their reimbursements to Medicare, and as Medicare drops its reimbursement, the same thing happens with private insurance. In primary care, when we see patients, we sometimes see people for multiple problems. Someone can come in for diabetes, but then also mention a pinched nerve, or something like that. It can easily double the amount of time with the office visit, but you don’t get reimbursed for the extra time. So it’s a major challenge.
The federal government was going to cut Medicare reimbursement by 10.8 percent next month, but by a last-minute action by Congress, it was delayed. But it’s just a delay - they’re scheduled to enforce the cut in the next few months.
So that is going to be a major thing, and that’s just the beginning. The fear is that there are going to be a lot of doctors who are going to stop taking Medicare patients. Medicare patients take up a lot of time because they are older, have multiple diseases and are taking multiple medications. Even, for instance, the flu shot. We never know what the payment is going to be for the shot until we submit claims. And the vaccine manufactures, every year they raise costs. This year my nurse told me that when we were reimbursed for our first batch of vaccines, we were actually losing money on the shot. So there are a lot of pressures on primary care doctors because most of what we do is face-to-face time with patients or direct patient care.
What are some of the medical aspects of global warming that you feel strongly about and try to educate your patients about?
I have to admit I haven’t gotten that far yet, but I would like to produce some kind of newsletter for my patients or put stuff on a website. There are different types of ways that human health is affected by global warming. For instance, as the Earth gets hotter, there’s heat stress. People get heat strokes and people are more prone to dehydration. In 2003 in Europe, about 35,000 people died when they had a heat wave where the temperature was about 10 degrees higher than the regular summer temperatures. In Chicago about 10 years ago, almost 500 people died from heat stress. So that’s one aspect.
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As the world gets hotter and the surface temperature goes up we also get more things like El Nino, where storms are worse. Even some simple things - they’re thinking that there is going to be more malaria because as Earth gets hotter, the warmer latitudes move farther north and south of the equator. The mosquito that carries malaria will then be able to spread further.
There’s also a liver parasite that’s present in Asia. When I was in medical school, they said it was the No. 1 reason for people getting liver cancer in Asia. There is this thing called the freezing line, where the parasite cannot survive in the water. So that freezing line is actually extending farther north and farther south. So they’re thinking now that worldwide, 21 million more people are going to be at risk for infection of this liver parasite.
Even things like allergies - they’re finding that the pollen season is starting earlier and earlier, so people who are susceptible to allergies will have problems earlier and for a longer length of time.
So there’s all that stuff.
Can you talk about carbon footprints?
A carbon footprint is how much in the way of carbon dioxide emissions an individual generates per year. Everyone has a carbon footprint. You can go to http://www.epa.gov for a calculator. It’s really good because on one screen, you can actually figure out how you can lower your footprint. We used to have two cars and when it was time to change cars, we decided to get rid of one and got a Segway. By doing that, I now produce something like 2 tons less of carbon dioxide a year. They say the average person in the U.S. produces somewhere between 20,000 and 40,000 pounds of carbon per year. Even doing simple things; for instance, in our house we changed 14 light bulbs from regular to compact fluorescents, and just by doing that we produce something like 1,800 pounds less of carbon dioxide a year. And by recycling and doing things like that you also reduce your carbon footprint.
Can you discuss your involvement with the Hawaii Medical Association and the Honolulu County Medical Society?
I’ve been a member for my entire career. It’s important to give back to the community, so for me that’s giving back to the medical community. I get involved with committees as an officer with the Hawaii Medical Association and the Honolulu County Medical Society. I was elected president of the Honolulu Country Medical Society for this year and the following year, so I have two years to try to do things. What I’d like to do with my two years as the Honolulu County president is to get in touch with the state to see if there are ways to help doctors be able to practice in a time of disaster or when there’s no power. When we have disasters, most of us doctors have everything on computer, a lot of phones are run dependent on AC power. So when things like that happen, how are we going to see patients? How are we going to get prescriptions to pharmacies? Weeks ago this building lost power, but I was still able to see patients and practice in the dark because I have some information on my PDA (personalized digital assistant), and when I got phones, I got phones that will run off the phone line so I don’t need AC power. And I have a headlamp. I have a solar battery charger so I could power my headlamp and my PDA.
So part of what I want to do is take disaster planning down to the grass roots to see if there are ways that physicians in the community can continue to care for our patients in times when it would be difficult.
This information is provided as educational and is not intended as a substitute for consultation with a physician. For questions, consult your physician or call the Honolulu County Medical Society, of which Dr. Roger Kimura is a member, at 536-6988.
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