EXPERT > Doctor In The House

Importance Of Primary Care

By Dr. Baron Ching
Interviewed by Melissa Moniz
Wednesday - May 26, 2010
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Dr. Baron Ching
Internal Medicine, Rehabilitation Hospital of the Pacific

How long have you been practicing?

Since 1983. So that’s 27 years in this very same Nuuanu office.

Can you discuss what your role is as an internal medicine physician?

I do primary care. That basically means taking care of people. As an internal medicine guy, I take care of mostly adults, not pregnant women or children. We don’t do surgery. Primary care has evolved into its own. It used to be just general practice kind of stuff, but it’s changed. We have more medicines and knowledge. We can actually do things for people now that we could never do before, such as hypertension, diabetes, heart disease, renal disease. This all happened as recently as maybe 10 years ago. The action now is on prevention. But part of the problem is that primary care hasn’t had a lot of respect. We don’t do procedures; the things we do are more diagnostic. So what happens is that we don’t get the kind of reimbursement that other procedure-based specialties do. The paradoxical thing is that, as a specialty, primary care is more and more effective, and yet because we don’t have that kind of reimbursement we can’t get people to do it. You’ve heard about the doctor shortage. They estimated in Hawaii that we’re short about 500 primary-care physicians. It used to be that the problem was just on the Neighbor Islands, but it turns out even here in Honolulu there’s a shortage. Under the Obama bill, the emphasis is on prevention, which is what we do and we do it very well. But the problem is that they need to do something about the reimbursement.

Is there anything of concern that’s on the rise right now?

Kidney disease is way up there. Also, a lot more diabetes. We’re having a lot of problems with obesity and also the general things associated with getting older.

You also have an interest in Hawaiian history, and I hear there’s some interesting information about the land that your office (Kuakini) and REHAB are on.

I am vice chair of Aha Hui Malama O Kaniakapupu. We’re a group that has partial steward-ship of Kamehameha III Summer Palace in Nuuanu. One of the things we try to say is, if you want to know where you are going, you need to know where you are coming from. So that’s one of the reasons we look into this kind of thing. The area around here is very old and associated with a lot of legends. Of all the places in Hawaii, this may actually be the most important and associated with the most Hawaiian gods, but not many people realize this. This area has been associated with the four principal gods of Hawaii: Ku, Kane, Lono and Kaneloa. It has been associated with the populating of Hawaii. And the highest heiau of the Honolulu series was Kaniakapupu, which was a healing heiau. It was manned by the kahuna of Lono, who are actually healing priests. Their job was to administer to the people traversing over the districts of Koolau and Kona. It was said that they had gardens of every medicinal plant up there. It’s not there anymore because we’re talking about more than 1,000 years ago. But that’s where it was traditionally.

Are those medicinal plants available anywhere?

The problem is that the knowledge has been lost on how to use them. When Cook stumbled upon Hawaii there was an estimate of about 1 million Hawaiians, and they say that by 1900 there were only 40,000 Hawaiians left, so 960,000 of them perished. So there was a cultural collapse. What happened is that a lot of the knowledge was lost and a lot of the practitioners died, taking their knowledge with them. Some of the plants probably still do exist, but the knowledge on how to use them is lost. We’re trying to resurrect that kind of stuff.

Is there anything new or exciting happening within your practice or in internal medicine?

I think we’re going to have a primary care crisis. We’re in the middle of having it right now. I think it’s going to be really tough the next few years. On the Neighbor Islands, people with good insurance are having a hard time finding primary care doctors. And I think that we’re headed to that here in Honolulu, the urban core. So right now the medical school is trying to up production of primary care. But there’s going to be all kinds of changes, again just because of demographics. With the population getting older, there will be a bigger need for medical care and there will be fewer taxpayers to support this. As a society, we have to prioritize what we want to spend our money on and where we want to put our health-care dollars. That has to happen, because without it the system is going to collapse.