A conversation with Donna Sweet
06/08/2014 7:22 AM
08/08/2014 10:24 AM
Donna Sweet thinks she was an unlikely person to become a doctor.
The oldest of eight kids, she grew up on a farm 40 miles east of Wichita and no one in her family had ever gone to college.
“I had some very dedicated science teachers at Circle High in Towanda who really pushed and thought that I should be able to get to college. They helped me apply for, and I did get, the Gore Scholarship at Wichita State, which at that time was the only full scholarship and the only reason I got to go to school,” Sweet said.
Sweet is president of the Medical Society of Sedgwick County, professor of internal medicine and a clinician at the KU School of Medicine-Wichita where she focuses on treating patients with HIV and AIDS.
Before attending medical school at KU, Sweet worked in microbiology research. She joined the KU faculty in 1982.
When she isn’t working, Sweet enjoys cooking and traveling. She has spoken to health care professionals around the world about HIV and AIDS and was part of the Eurasian Medical Education Program, traveling to Russia 16 times to educate physicians on HIV and tuberculosis.
What drew you to working with HIV-positive and AIDS patients?
Nobody knew what caused it. That was in 1981. I was following the epidemic for academic interest, having been in immunology and microbiology, and my husband is a Ph.D. immunologist.
There was a young man that came into town, and he asked around about who was the AIDS doctor, and everybody gave him my name, and I figured I could do as well as anybody.
There wasn’t a lot of competition for the population among clinicians and physicians because there was so much fear and hysteria. ... He was an activist and drug me with him to a lot of things, so we got started trying to understand what it was and wasn’t and therein was my beginning career in HIV and AIDS. It’s just been my passion ever since, both educationally to try to help people understand what it is and how to keep from getting it, but as well as treating it.
It’s just truly amazing to me. I can look at my career, and I’ve been at this now 32 years, and when I started with that young man and with AIDS, it really was a death sentence. The average survival was six months and we had nothing to do other than try and make the death as comfortable as possible, which is never very good.
And now you fast forward to 2014, and people get themselves tested, come in, get care and take their medicines. If we can keep them on their medicines, their lifespans should be no different than somebody the same age with the same conditions. It is truly remarkable.
A lot of my work is now much more political because for a lot of patients to do well with HIV, they have to be able to access care and get the medications. The average medicine is somewhere between $2,100 and $2,500 a month.
What do you think is the top issue facing physicians?
The Affordable Care Act moves from a system of what I call piecework – being paid for each individual thing you do – to a system where hopefully you’re paid based on quality and outcomes. That’s a huge systems change for people like me. ...
Simply understanding it and knowing how to continue to take good care of the people you want to take care of and still keep your doors open is increasingly difficult because of the payment mechanism and all of the hoops we have to jump through for quality reporting. We’re all struggling with new computer systems and electronic health records.
But it’s an exciting time. I tell my residents and students it’s something one should embrace because I think at the end of this we will come up with a much better system for our patients, and that’s ultimately what this is all about: taking as good of care of patients as we can.
Medicaid expansion is still a hot topic among providers. Do you think it will happen in Kansas?
I doubt that Medicaid expansion will happen with the current administration. It’s always hard to predict the future, but it doesn’t look feasible with the way it’s been set up.
I think it’s a real problem because what that does is leave our very poorest people without anything. ... You don’t get subsidies and you can’t buy into the exchanges without those subsidies, so that’s a place where Kansas has definitely left its citizens behind.
How do you think the first year is going for the Affordable Care Act’s marketplace?
I’m a believer in universal access to health care coverage. We cannot be a developed nation unless we come up to speed in getting all of our patients and all of our citizens into health care. That’s what really sets us apart from the rest of the developed world, which does better in terms of quality outcomes: length of life, neonatal mortality, perinatal mortality. We have a great system if you’re in it. But if you’re not in it, we don’t do very well. Access is critical. Now, how you do it? The ACA tries to do it in a capitalistic, insurance-based private model, which is fine with me, but that’s a lot of change and for many, many people, this has been a godsend.
At least my patients who have gotten into (the marketplace) have been very pleased and, quite frankly, have found it cheaper, but a lot of these were people with pre-existing conditions that were paying out the wazoo for plans to get just catastrophic coverage.
What piece of advice would you give to young people who are thinking about going into medicine?
I think medicine is absolutely the best profession in the world. Young people tend to be philanthropic and high-minded, and if you want to be able to truly help people, medicine allows you to do that. It’s such a rewarding profession because it allows you access to in-depth understanding of people and their problems that nothing else ever would allow you to do.
So consequently you’re endowed with a great deal of trust, and people are confident that you’re there to take good care of them, which I am and I think most doctors are. So it may not be the way to become a billionaire in this country anymore, but if you get into medicine to help people heal, which is why I got into it, you can’t beat it.