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The lower incident rate is also a function of the fact that American Indians have a shorter life expectancy that other populations in the United States. (Most cases of colorectal cancer are diagnosed in people ages 50 and older.) In addition to higher rates of tuberculosis and alcoholism, American Indians are more likely to die in car crashes, commit suicide and be murdered.
On the trip back from White Cloud, Greiner works on paperwork related to his duties as the chief medical officer for the Unified Government of Wyandotte County. In this role, Greiner is more of a technical adviser than an administrator. He focuses on the medicine and allows Joe Connor, the director of the Public Health Department, to manage the operation.
Connor is grateful for Greiner's expertise and his willingness to share it with the community. "He does way more than the minimum for us," Connor says.
Greiner has worked with Connor's staff to make the Public Health Center, a three-story concrete building attached to City Hall, into a doctor's office that can function without a doctor being present. Greiner has designed protocols, for instance, that allow the clinic to treat sexually transmitted infections (STI) without his having seen anyone.
"No one leaves here without a scrip," says Greg Stephenson, who heads the community health unit. "They leave here with medicine in their bellies or in their veins."
Wyandotte County has the highest STI rate in Kansas — the Unified Government buys penicillin in bulk. The Public Health Center meets the high incident rate with an aggressive approach. If a woman comes to the clinic and is diagnosed with chlamydia, her partner can obtain medicine without an exam. "He doesn't even have to unzip," Stephenson says.
Stephenson and others at the Public Health Center appreciate that Greiner treats them as peers. Nurses who suggest ways to improve the protocols receive e-mails from Greiner, signing off on the change. "He always listens to us," says Jeanne Bennett, a nurse at the clinic. "And if it's for the patient, he's all for it."
Empowered by Greiner, the Public Health Center performs a range of tests and provides a variety of services. Greiner and Bennett collaborated on protocols to encourage vaccination against the human papillomavirus (HPV). More than 5,000 patients who came through the STI clinic received vaccines for hepatitis A and hepatitis B. The clinic manages the prenatal care of pregnant women and inoculates international travelers against yellow fever and other infections.
The Public Health Center is able to deliver this care at a reasonable cost. A gonorrhea case that might cost $1,000 to treat in an emergency room can be handled for about $65. Stephenson says the clinic is a model for health-care reform.
"We're probably doing this for five cents on the dollar or less," he says.
Working with the Unified Government allows Greiner to be a physician and public health official at the same time — the kind of doctor who can undertake the systemic changes that Greiner has wanted to make since he was in medical school.
"If we really want to say that what we care about is improving people's health, it can't just be doing procedures on people and tests on people in here," he says, sitting in his office inside a new building at KU Med. "It needs to be bigger, broader and messing around at all those levels."
Too often, Greiner says, doctors can't see past whatever organ system is their specialty.
"We're always reducing our level of focus, lower and lower," he says.