02-19-2017  1:20 pm      •     

In the seven weeks since it opened, Nurse Practitioner Shelda Holmes' new Hands On Medicine clinic has attracted a following of North and Northeast Portland's most underserved residents.
For Holmes, it is a dream come true.
"My passion is in serving the underserved," Holmes says.


In former jobs, Holmes sometimes saw more than 24 patients each day, and had barely 10 minutes per person to diagnose and treat their problems.
"How can you treat someone in 10 minutes?" she says. "It's not fair to the doctors and it's not fair to the patients."
Holmes, who works on health care-related policy issues throughout Oregon, says she believes one of the reasons behind the state's current nursing shortage is that nurses can't treat patients the way they want to in such a tightly controlled, time-crunched environment, so they opt out of the profession.
This was the reason for Holmes' move as well.
After years of working as a floor nurse and in hemoncology at Oregon Health Sciences University, Holmes opened her own practice, Hands On Medicine, a clinic situated one block south of Killingsworth Avenue at 5311 N. Vancouver Ave., in early February.
"My mission is to treat families in the most sustainable way possible (Holmes has purchased sterile cleaning equipment to reuse all the medical supplies she can, making exceptions for non-reusable items such as needles) and I'm committed to spending 30 minutes with each patient," she says.
Holmes is one of five primary care providers currently accepting Care Oregon patients, and the majority of her patients are Medicaid clients.
The reimbursement rates for Care Oregon and Medicaid aren't great, Holmes says.
"I just billed Care Oregon for $2,300 and they sent me an $800 check. This is the only industry in the world where a company can say, 'OK, we'll pay you 30 percent of the bill and there's nothing you can do about it.' If I'm lucky, I'll resubmit and they'll send me another $200."
About 70 percent of the patients coming to Hands On Medicine are people of color and the majority of them live close by.
"I've had people stop in who were just walking by, and they say, 'Oh, do you take my insurance because you're so much closer than my (current provider),'" Holmes says.
And for the uninsured, cash-paying folks out there – and Holmes sees a lot of them – she offers a 25 percent discount.
Although Holmes is a nurse practitioner, which means she can do most of the things a regular medical doctor can do, including writing prescriptions, doing well-baby check-ups, and prenatal care up to 25 weeks, she also wanted to offer a few alternative, complimentary treatments at Hands On Medicine. The clinic employs one licensed massage therapist – David Imeson has more than 10 years experience in Swedish massage and is offering a "new patient special" right now of $40 for a one-hour massage.
In April, Hands On will offer acupuncture; and Holmes has set aside a room for educational seminars on topics like diabetes and high blood pressure.
One other feature that makes Hands On Medicine stand out is the use of local art to brighten the walls, children's exam room and reception area. Holmes has found three local artists to decorate the clinic for its grand opening on March 29 and plans to rotate artists every few months.
"It connects us to the community," she says. "And I think there's a connection between art and healing."

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  • WASHINGTON (AP) — One month after the inauguration, the stretch of Pennsylvania Avenue in front of Donald Trump's White House still is a hard-hat zone. Skeletal remains of the inaugural reviewing stands poke skyward. Random piles of plywood and cables are heaped on the ground inside crooked lines of metal fencing. The disarray outside the president's front door, though not his fault, serves as a metaphor for the tumult still unfolding inside. Four weeks in, the man who says he inherited "a mess" at home and abroad is presiding over a White House that is widely described as itself being a mess. At a stunning pace, Trump has riled world leaders and frustrated allies. He was dealt a bruising legal blow on one of his signature policies. He lost his national security adviser and his pick for labor secretary to scandal. He's seen forces within his government push back against his policies and leak confidential information. All of this has played out amid a steady drip of revelations about an FBI investigation into his campaign's contacts with Russian intelligence officials. Trump says his administration is running like a "fine-tuned machine." He points to the rising stock market and the devotion of his still-loyal supporters as evidence that all is well, although his job approval rating is much lower than that for prior presidents in their first weeks in office. Stung by the unrelenting criticism coming his way, Trump dismisses much of it as "fake news" delivered by "the enemy of the people" — aka the press. Daily denunciations of the media are just one of the new White House fixtures Americans are adjusting to. Most days start (and end) with presidential tweets riffing off of whatever's on TV talk shows or teasing coming events or hurling insults at the media. At some point in the day, count on Trump to cast back to the marvels of his upset of Democrat Hillary Clinton in the November election and quite possibly overstate his margins of support. Expect more denunciations of the "dishonest" press and its "fake news." From there, things can veer in unexpected directions as Trump offers up policy pronouncements or offhand remarks that leave even White House aides struggling to interpret them. The long-standing U.S. policy of seeking a two-state solution to the Israeli-Palestinian conflict? Trump this past week offered this cryptic pronouncement: "I'm looking at two-state and one-state, and I like the one that both parties like. I can live with either one." His U.N. ambassador, Nikki Haley, the next day insisted, "We absolutely support a two-state solution." Trump's days are busy. Outside groups troop in for "listening sessions." Foreign leaders call or come to visit. (Or, in the case of Mexico's president, cancel out in pique over Trump's talk about the planned border wall.) After the president signed two dozen executive actions, the White House was awaiting a rush order of more of the gold-plated Cross pens that Trump prefers to the chrome-plated ones used by his predecessor. Trump hands them out as souvenirs at the signing ceremonies that he points to as evidence of his ambitious pace. "This last month has represented an unprecedented degree of action on behalf of the great citizens of our country," Trump said at a Thursday news conference. "Again, I say it. There has never been a presidency that's done so much in such a short period of time." That's all music to the ears of his followers, who sent him to Washington to upend the established order and play the role of disrupter. "I can't believe there's actually a politician doing what he says he would do," says an approving Scott Hiltgen, a 66-year-old office furniture sales broker from River Falls, Wisconsin. "That never happens." Disrupt Trump has. But there may be more sound and fury than substance to many of his early actions. Trump did select Judge Neil Gorsuch to replace the late Antonin Scalia on the Supreme Court, a nomination that has drawn strong reviews from conservatives. But the president is regrouping on immigration after federal judges blocked his order to suspend the United States' refugee program and ban visitors from seven Muslim-majority countries, which had caused chaos for travelers around the globe. Some other orders on issues such as the U.S.-Mexico border wall and former President Barack Obama's health care law are of limited effect. Trump says his early actions show he means to deliver on the promises he made during the campaign. "A lot of people say, 'Oh, oh, Trump was only kidding with the wall,'" the president told a group of police chiefs recently. "I wasn't kidding. I don't kid." But the Republican-led Congress is still waiting to see specifics on how Trump wants to proceed legislatively on top initiatives such as replacing the health care law, enacting tax cuts and revising trade deals. The messy rollout of the travel ban and tumult over the ouster of national security adviser Michael Flynn for misrepresenting his contacts with Russia are part of a broader state of disarray as different figures in Trump's White House jockey for power and leaks reveal internal discord in the machinations of the presidency. "I thought by now you'd at least hear the outlines of domestic legislation like tax cuts," says Princeton historian Julian Zelizer. "But a lot of that has slowed. Trump shouldn't mistake the fact that some of his supporters like his style with the fact that a lot of Republicans just want the policies he promised them. He has to deliver that." Put Senate Majority Leader Mitch McConnell, R-Ky., in the camp of those more interested in substance than style. "I'm not a great fan of daily tweets," McConnell said Friday, referring to the "extra discussion" that Trump likes to engage in. But McConnell was quick to add: "What I am a fan of is what he's been actually doing." He credits Trump with assembling a conservative Cabinet and taking steps to reduce government regulation, and promised: "We like his positions and we're going to pursue them as vigorously as we can." The challenge may be to tease out exactly what Trump wants in the way of a health care plan, tax changes and trade policy. At his long and defiant news conference on Thursday, Trump tried to dispel the impression of a White House in crisis, squarely blaming the press for keeping him from moving forward more decisively on his agenda. Pointing to his chief of staff, Reince Priebus, Trump said, "You take a look at Reince, he's working so hard just putting out fires that are fake fires. I mean, they're fake. They're not true. And isn't that a shame because he'd rather be working on health care, he'd rather be working on tax reform." For all the frustrations of his early days as president, Trump still seems tickled by the trappings of his office. When New Jersey Gov. Chris Christie visited the White House last week to discuss the national opioid epidemic over lunch, the governor said Trump informed him: "Chris, you and I are going to have the meatloaf.'" Trump added: "I'm telling you, the meatloaf is fabulous." ___Follow Nancy Benac on Twitter at http://twitter.com/nbenac
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