The waiting room is bright and colorful, stocked with stuffed animals. A video plays on a television set to keep children distracted long enough to forget they are scared about being in a doctor's office.
Dr. Rich Greene has been a practicing pediatrician for 27 years, mostly at the Palo Alto Medical Foundation. Along with seven other pediatricians, he cares for children, and also develops relationships with their parents and families. Because it is a group practice, he has gotten to know not just his own patients but those of his colleagues as well, since they trade off being on call.
Like the safe world of the waiting room, pediatric medicine, in Greene's mind, has remained relatively insulated from the changes going on in health care for adults. One reason may be that clinics such as the Palo Alto Medical Foundation are on the forefront of delivering care in a cost-efficient manner, and in many ways are models for the kind of health care reform now under discussion in Washington, D.C.
Greene, noting that he speaks for himself rather than for the clinic as a whole, expects that because he already is used to group health care, the reforms being contemplated wouldn't be as jarring for him as they may be for other doctors.
"We at the Palo Alto clinic, because we are used to operating as an HMO . . . (have) a huge jump on delivering health care," he says. "We're used to being collegial. We're used to being communicative with each other about patients. We're used to covering each other's patients (and) our patients are used to having someone else take care of them, as is the case with an increased volume of patients."
Since the pediatric department extended its hours from 7 a.m. to 10 p.m. daily in order to increase patient access to doctors, the patient volume per doctor has also increased.
"There is a little bit of a tradeoff," says Greene. "By being more accessible to our patients, we're seeing more patients. (But) in seeing more patients, we are taking care of more things on our own and trying to get the patients to be seeing us rather than seeing specialists."
This is a big target of the health care reform wave sweeping the country: primary care physicians are put in the role of gatekeepers, screening patients' concerns and complaints, and helping to keep the patient from having to spend more insurance dollars going to a specialist when they don't really need to.
A disadvantage of reforming the health care system is when it forces people to change insurance plans, and ultimately change doctors if they are not on their insurance company's "list."
"It does interrupt this whole issue of personal care that we pediatricians, and me in particular, try to do with a family," says Greene.
But Greene sees less switching of doctors in pediatrics than in other areas of medicine. "Patients do a lot not to change their pediatric loyalties. A number of patients I have will even continue to come to me even if their insurance doesn't cover the Palo Alto Clinic because they're not as afraid of the big expense of pediatric care because it doesn't exist very much."
In spite of daunting issues that are discouraging many would-be doctors from pursuing medicine, Greene remains staunchly optimistic about the future of his field, even to the point of encouraging his son to go into medicine. The son, 28-year-old Brad Greene, is now an ear, nose and throat specialist.
"I would go into medicine again knowing what it's like now, absolutely, because of the value that we (pediatricians) have to families, the intimate relationship we have with families, which is absolutely not changed by health care reform," Greene said. "I still feel that I have a very personal relationship with all these patients, and health care reform really is not interfering with that. It is a deeply satisfying, daily enjoyable experience."
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