Dr. Thea James gave a lecture entitled “Medicine for Mission: Shifting the Paradigm” as part of the Park Street Corporation Series at Boston College on Thursday evening. The lecture was cosponsored by the PULSE program in celebration of their 50th anniversary.
James’ passion is public health, both domestically and locally, and, in 2008, she received the David H. Mulligan Award for public service. Currently, James is an Associate Professor of Emergency Medicine at the Boston University School of Medicine. She also works at the Boston Medical Center, where she serves as the Vice President of Mission for the hospital.
At Boston Medical Center, James directs the Violence Intervention Program Advocacy Project, works in the ER two days a month, and is the Associate Chief Medical Officer.
Her great insight into emergency medicine and human health is, “given any opportunity, people will not choose suffering.”
In Massachusetts, Medicaid began to increase, eventually taking up nearly half of the state budget. During this time, the reimbursement method was a fee for service model. This meant that every time a person got admitted, the hospital would receive payment. This ultimately prevented doctors from focusing on examining the root causes medical problems.
Now, the method is value based. There is a certain amount of money allocated per patient, per month. This method encourages doctors to attempt to reduce multiple admissions and discover the cause of the problem.
“Boston likes to tout itself as the Mecca of Healthcare' but it’s having absolutely no impact because of the way that medicine is designed and how we are taught to think about medicine,” James stated.
She then went on to describe two main ways of providing treatment: upstream and downstream.
Treating a patient “downstream” means treating whatever the patient came to the emergency room for, without examining the larger context for the medical emergency. By treating people “upstream,” the doctor would examine the patient and, through conversation, determine what needed to change in order to prevent this medical emergency from happening again.
“The hardest thing is mindset,” James said. “You have to ask the patient what it would take for this to never happen again.”
“If you set high bars, that’s what’ll happen. Where you set the bar becomes a self-fulfilling prophecy,” James stated.
Boston Medical Center has, in the last two years, began to explore what is possible for hospitals to do when it comes to changing the community. Whenever a hospital expands or does any type of construction, 5% of the total cost of the construction has to go to the community. Boston Medical Center asked the Massachusetts government if this 5% of their campus redesign budget could go toward funding housing projects, enabling the construction of nine different housing projects.
After James’ lecture, there was time for audience questions.
An audience member asked James, “How has the reaction been nationwide to redefining the roles of what a doctor should be?”
James said she believes that the medical community is responding well to the idea that a hospital is not only responsible for treating the patient in the emergency room, but also for working to fix the problems that led to the hospital visit in the first place.
“Housing is a big deal,” she stressed, “but I also feel like the economic mobility piece and financial stability, that stuff is equally important.”
“People talk about different domains—education, food, these different things. You know, financial independence is the only thing that will take care of all this,” James argued.
Another audience member asked, “What policies or proposals do you think could bring about financial independence for everyone?”
James specifically mentioned doing away with programs that make people work simply for the sake of working. There is a difference between making people work a certain number of hours to earn subsidies, and helping people find work that will improve their lives.
“The other thing is lifting this whole notion of limiting how much money people can earn to live on subsidies,” she said.
By limiting the amount of money people can earn to live in, say affordable housing, people are unable to save enough money to support themselves. This cap on income prohibits financial independence.
The lecture concluded with an audience member asking, “What would be your motivation for doing this demanding complicated work?”
“It’s interesting. It’s challenging. You get to disrupt stuff,” James concluded. “You get to alter people’s life course.”