Conversations With Ananda — Ch. 30, Dr. Peter Van Houten, MD

Dr. Peter in 1980.

In 1982, Peter Van Houten, MD started a medical clinic in the Sierra foothills outside Nevada City, California, just across the road from Ananda Village. The Sierra Family Medical Clinic (since renamed Sierra Family Health Center) serves more than 9000 patients who formerly had to drive twenty to seventy miles for medical help. The clinic has overcome numerous obstacles over the years, including inflexible county zoning ordinances and a doctor‑hostile, HMO‑dominated medical culture.

Q: Lots of doctors nowadays are refusing to treat patients who have government insurance, yet the Sierra Family Medical Clinic doesn’t turn anyone away. How does that work for you?

Dr. Peter: We realized when we opened the clinic in 1982 that the Medi‑Cal program took a tremendous bite out of doctors’ fees. At the time, it paid about seventy-five cents on the dollar, and it later got cut back to fifty cents. So Medi‑Cal went from something that most doctors didn’t want to take and were trying to minimize, to something that many physicians outright refused.

We opened our clinic at about the time this was happening, and one of the first things we realized was that if we wanted to practice in this rural area, all of us would have to accept a modest salary. Consequently, most of the staff make less than they would be paid by a similar clinic in Nevada City or Sacramento, and most of the healthcare providers that work here are making somewhere between half and a third of what they’d make for the same work in an urban or suburban area.

It goes with the territory. We view what we’re doing as a ministry, as our way of caring for people in this area and of doing something that is a kindness and pleasing to God. We’re taken care of financially well enough that we can live comfortably and make ends meet, but it certainly doesn’t look like a typical physician’s lifestyle in Sacramento or San Francisco. It’s something we’ve all done by choice. The flip side is that we feel well connected to our patients, and we know we’re doing something that makes a tremendous difference in people’s lives.

I think that if you talked to most people at the end of their lives, they would say the financial rewards weren’t worth as much as they thought they would be.

What we’ve try to concentrate on is the spiritual gains of caring for people and being friends to them and ministering to them. Most physicians will say, “We don’t want to take care of Medi‑Cal patients because it’s poorly reimbursed and they’ll probably sue us. They’re poor people, and they just want to grab the brass ring and sue us physicians to make money.”

In truth, I think most doctors don’t want to take care of people who have Medi‑Cal because there’s a possibility that they’ll smell bad and won’t do what they’re asked. Some drink, and some are on drugs, and they may be violent and difficult to work with. So if you want an easy way to keep those people out of your practice, you can do it by saying “I’m not going to accept Medi‑Cal,” and suddenly all of these potentially difficult people are no longer in your practice. In fact, I’ve had more than one physician tell me that the best thing they ever did, and the thing that made the biggest difference in enjoying their medical practice, was to eliminate Medi‑Cal patients.

What we’ve done is to say that we’re going to see these people regardless. And that’s part of the reason why a practice like ours is so people-intensive. When you’re trying to work with somebody who’s crazy or poor, you may have to spend a lot more time to achieve a good outcome than with somebody you can just gently nudge in the right direction. You basically have to educate them from the ground up. A patient in an urban practice is more likely to do what you ask, like not smoking or drinking while they’re on an antibiotic. But in an area like ours, they’re just as likely to go home and stay smashed for a week because their foot hurts. Which, of course, can really interfere with the treatment plan.

Q: How do you manage the treatment for those people?

Dr. Peter: I think it boils down to seeing what you’re doing as a service to God, and to seeing God in the people you’re taking care of.

A story that I find spiritually comforting is the one about St. Francis and the leper. In the times when St. Francis lived, lepers were social outcasts and very frightening, because people were worried about contagion. St. Francis was walking down a road one day when he was confronted by a leper, and his first response was to run away. I think it would be hard for us to imagine the level of revulsion that someone might feel in that cultural era. Yet he felt that this was a child of God, and that he needed to worship God in that leper. So he went up to the leper and kissed him on the mouth, or what was left of his mouth, as an act of love and service to God. And when he had done that, he felt God’s presence, and after he turned and began to walk away, he turned again and the leper was gone. Clearly, it had been a test of God, to help him overcome his human revulsion at serving people who were less fortunate.

I think that in our own little way, we’re learning to see that the patient is God, to care for people with the thought that we’re there to minister to them, and that our ministry just happens to be with antibiotics and casting plaster and x‑rays. For a lot of these people, it’s probably the kindest they’re going to be treated in their lives. We treat them like human beings, and we try to respect them.

Some of our crustiest patients can be fairly abusive. We’ve had to tell people, “Look, when you come into the clinic, you can’t swear – it’s not okay, and you can’t come in and call our receptionist a bitch. You can’t use bad language around us, because we won’t let you come here.” They realize they’ve got something good, so they cooperate. We don’t have to do that very often.

Q: Have you experienced spiritual benefits from this work?

Dr. Peter: I think nothing comes to us in this life that isn’t ours. So I can’t help but believe that God is behind everything that’s come to me as a physician. And as uncomfortable as many of the challenges have been, I’d have to say in retrospect that it’s been what I needed.

It’s been a crucible for my spiritual development. When I was going through it, I may have squirmed like a bug that was pinned to the wall, because it was uncomfortable. I hated aspects of it, because they produced suffering in me, and because there were parts of my personality that I really needed to change. It’s one of those things where you say, “God, why me?!” I felt pummeled to a little bloody pulp while I was going through it, but I’m glad for it, because I feel that it changed me in ways that another setting wouldn’t have.

I could have insulated and isolated myself to make it comfortable, but I was involved in something that had its own momentum, and many times I felt dragged along, rather than leading the process with foresight and planning. Every day, I didn’t know what would happen the next day. I feel I probably benefitted the most then spiritually, because there was no option for me to shield myself. I felt like I was on the rack, getting stretched every day, and there was nothing I could do except go and do it with the best attitude I could. And I really got pushed to my limits, often. I thought many times about quitting, because I felt it was too hard. But somehow Divine Mother kept me with it. She kept my spirits up, or She got me enough of a break, or enough meditation, or got the right attitude into my mind so that I could survive.

It’s really helped my faith in God, because so many things have happened for us that have been miraculous. For example, we had tried for many years to get land for our new clinic, and then finally, just at the point when we really had to have it, we got it. There was nothing else in the area for sale, and we really had to buy something, and the property that became available was the one we really wanted, in our hearts.

That’s just one example. Running a rural clinic, you’re very aware of finances all the time. And whenever I would look over the $350,000 or so that the clinic had earned during the year, I’d find that after paying salaries and expenses we would be $1000 or $2000 above or under the exact amount we needed to make it through the year reasonably comfortably. We never made a whole lot more than we absolutely needed, but we never had any really big losses, either. Somehow at the end of the year we would have made just enough to pay our bills, or just a little more. And if we had a little more we’d give the staff a little bonus at Christmas. If we were a little short, we’d just have to work harder the next year to make up for it.

It was never like we got hammered financially and had to go borrow $100,000 just to stay open. But then again, we never made a whole lot extra, either. So there was always the feeling that in the end, God was in charge of the show, and we just had to put out the best energy we could, and somehow the details would get worked out.

Today: the staff of Sierra Family Health Center (Dr. Peter at upper left)

Q: Can you talk about the staff, and how they maintain their morale while they’re working here?

Dr. Peter: I think the way we work things out has been very much by the group’s magnetism. One of the things I learned early on is that there’s very little you can really say to someone about what you’re doing. I mean, you can talk a good line, but in the end people are going to watch how you behave, how you act, and how you actually do things. That’s what they’re going to be magnetized by.

I think that’s one of the reasons our first three or four years were so difficult. There were very few of us, and we were new to what we were doing, so it was hard to create a coherent magnetism that could draw a new person into this smoothly functioning spiritual energy. I always felt we were like a flywheel that’s a little off balance, like we were real close to being on key and getting everything working well, but it was hard to take on somebody new and blend them into our energy.

In some ways, our whole scene was very vague. We were trying to figure out how you blend doing a ministry of healthcare with giving somebody antibiotics. We were asking if we should be doing more alternative care, or if we should forget about it and just do what’s needed. Because we had other problems we were wrestling with, and our magnetism as physicians and as a clinic was a little murky.

Then we were also worried about the county. There were many pressures on us, but since around 1990 our magnetism has become much more clear. We have a big staff, about twelve people, and almost everyone has been here for four years or longer. A number of us have been here for ten years, so there’s a momentum.

A year ago, we switched from being privately owned to being a nonprofit foundation. I pulled out of the management quite a lot, and I was worried about what would happen to the flow of the clinic. I had tried to husband things along very consciously, and keep things in line, and work with everybody on the staff. And I realized that the magnetism at the clinic was wonderful, and that I could pull back and just be a physician. Since then, everything has been chugging along smoothly.

We’ve had changeover pains, as you would expect after a change in leadership. But the overall direction of the clinic has stayed coherent. The clinic’s doing beautifully, and when a new person comes in we don’t have to worry about telling them, “Well, this is our attitude toward our patients,” because they only have to work here a week and they’ll know what our attitude is. They’ll see how we handle difficult people, and how we work with people who can’t pay, and how we work with people that aren’t very bright, or are drunk, and so on. We really try to make our example the teaching aid, rather than lectures and sermons.

Q: Paramhansa Yogananda said that people who work in hospitals are cheerful because they’re serving others.

Dr. Peter: Yes, I feel that the people who come and see us are delighted to be treated lovingly and caringly. It’s interesting for me, because we’ll not infrequently have to send a patient out to a specialist for care, and it’s rare for someone to come back and say “Gee, thanks for sending me to that specialist.” They generally come back and say, “Why did you send me to that jerk – he treated me like I was stupid, and he only spent two minutes with me and charged me a hundred dollars.” Now we sort of warn people, “When you go, you need to remember that this guy’s a specialist. He’s not as interested in people, or he’d be doing what we’re doing, so don’t expect a great bedside manner. Don’t expect a lot of loving care. What you’re going for is to get your body tinkered with, like taking your car to a mechanic.” We’re real blunt, and we’ve had fewer complaints since we’ve started telling people that. They’ll come back and say, “You were right, it wasn’t very pleasant but he knew his stuff. Thanks for sending me.”

Over the years, we’ve had a number of patients who’ve become too difficult for us to care for, and we’ve tried to send them to other doctors who have complicated patients in their practice. And less than half the time, the patients stick. They’ll finally come back and say, “I don’t care if you don’t know as much; I want to come here.”

Q: Because they feel better?

Dr. Peter: Because they feel better. They say, “I’d rather die here early with you caring for me than live an extra year and go to somebody who treats me like a jerk.” I think that says a lot about the attitude we have toward our patients, that we don’t push them away with a cattle prod.

We have a fair number of people that come back every month, and it’s actually kind of a ministerial visit. We’re thorough – we listen to their heart and lungs, tap on their knees, talk to them about their health care, and make sure we’ve done a real medical visit. But really, often they’re just coming in to talk about their problems, and what’s going on at home. But that’s part of being a general practitioner in our area. People are going to see you that way.

Q: That must be a gratifying aspect of your practice.

Dr. Peter: Well, God is the doer, and when I serve God that way, I feel His joy.

 

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