Dear Dr. Bourne -

How very sad, and how very understandable, is your decision to terminate your practice of family physician to the West Marin community. Your very committed and humane approach to running a small clinic is rare in today's medical environment and it is no wonder that this diverse community is united in reacting with sadness and some anger to the stresses you have lived under being a good doctor and to the reality of losing such an able and kind physician.

Dividing my home between Berkeley and Inverness, I have (I should say 'had') an internist/family doctor in both locations. My very respected East Bay internal medicine clinic has lost several doctors in the last decade due to their dissatisfaction with the restrictions put on them by medical insurance companies. They felt that they really could not practice responsible medicine under these circumstances. My doctor and her remaining colleagues moved to smaller quarters. The office was competently run, but my doctor there was always stressed for time and appeared uneasy if I addressed more than one medical problem. At one point she told me that the required documentation to 'justify' to the insurance companies her treatment choices took more time than seeing her patients. A recent letter from her informed me that, due to the stresses affiliated with dealing with medical insurance companies, she is taking early retirement. She concluded her letter stating "I feel that we all would benefit from universal health care." When I repeated this statement to my politically very conservative otolaryngologist , he concurred.

This is a new phenomenon for members of the AMA and reveals, I believe, that doctors are no happier with the medical insurance industry than are American patients. A system which penalizes doctors for giving their patients quality care is, in my opinion, a disaster and needs overhauling. A facile statement, often made by politicians, claims that Europe's and Canada's type of medical care amounts to 'socialized medicine'. Anybody who is informed a bit about the industrialized countries of Europe knows that European society is healthily and happily capitalist, and well taken care of medically. It is indicative of the failure of the American healthcare system that I am losing 2 competent physicians from 2 small, well-run offices at the same time. And surely the sad scenario of the West Marin community losing a highly respected and loved doctor and their small clinic due to the shortcomings of the health care system is repeated in many other American communities. I find this an outrage.

While I am saddened to lose you as my physician, I am grateful that among your future plans you wish to address this problem at the political level to hopefully make our elected officials more aware of the dilemma of doctors and the dissatisfaction of patients with the current health care system. Thank you for your dedication to quality health care.

Christa Burgoyne

If anyone has any doubts about the crisis

Dear Molly, If anyone has any doubts about the crisis in the American health care system, he or she should take a good look at your situation.

Here you are, in a rural community which you chose because this is a place in which you wanted to practice medicine. Over 2,000 patients, from ranch hands to senior citizens, have profited from your medical expertise and human understanding.

Your education and medical experience are a powerful force and gift to those you serve. You have made a difference in the lives of each of your patients, whether it be with pre-natal care, cardio-vascular health, diabetes, or end-of-life issues. The sensitivity, follow-through, and caring attention you and your loyal staff give to each patient is valued throughout the community.

Because you are in private practice, and don’t have a large staff, your employees have to spend a large percentage of their time on paper work. You once told me that over 50% of your staff’s time is spent responding to the myriad forms required by different insurance companies. Each insurance company has its own protocols for ‘appropriate’ drugs to be prescribed, medical procedures to be followed, and time allotted for each patient visit.

These dictatorial requirements are obviously ridiculous. It doesn’t make sense that an insurance company can override the decisions made by the local doctor and waste irreplaceable time that could better serve those in need.

The core of the problem that is American health care today is in the intrusive control of insurance companies. This control is blighting doctors’ independence and integrity.

Good medicine is more than specific procedures and prescriptions to be given in ‘usual’ circumstances - it is the ability of doctors to see the essence of the problem, not just its manifestations. This is the reason that health care must be given back to the doctors - those who see individual patients, diagnose individual and specific needs, and, then, face-to-face with each patient, prescribe effectively for each person.

Molly, your energies and talents have radically improved our community. I am outraged and heartsick that you and your practice will be forced to leave. You are indeed the most healing, effective doctor I have ever known. I want you to know that all your patients will continue to work to find a way to bring you and your important practice back to West Marin.

With great respect and love,

Louise Landreth

P. S. In my opinion, the United States should institute a universal health care system modeled after those in Canada, England, France, and Germany. All citizens above a certain low income level would be required to pay into a ‘health care fund’ which all Americans could then use to pay for their various medical needs. Doctors would be in charge.

has been the best of all worlds

To Whom It May Concern,

The West Marin Medical Center with Dr. Bourne and Dr. Whitt has provided us with wonderful professional medical care over the past many years. As residents of West Marin and as Kaiser members, it provides us easily accessible services to meet our medical needs as situations occur. To us, the ability to have a local center with dedicated doctors and staff who are part of the community has been the best of all worlds.

We sincerely hope that the present situation can be resolved in a way so that the center can stay open and continue to provide its much needed and appreciated medical services.

-- Ron, Charlene, Garrett & Gregory Casassa

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effect radical change in our ever-so broken health care system.

Dear Dr. Bourne,

I feel unbearably heavy hearted that you will be "closing shop" so soon. May this present situation generate such resonance and reverberation as to effect radical change in our ever-so broken health care system. And yes, I absolutely want to be notified if ever you decide to come back to practice medicine in West Marin on a limited consultation/retainer basis.

With sadness, Rose Hulls
                                   *******

I will probably leave Kaiser now

Dear Dr. Bourne,

I wanted as soon as I saw your letter to patients about the closing of your practice at West Marin Medical Center to write to you....then I thought of how very many letters, calls, and appointments you must have during these last months of your time in West Marin.

I did notice the last time I saw you that you looked distressed. I wanted to ask why, but thought that might not be appropriate in a professional relationship. You are simply the best doctor I've had in my adult years. I loved seeing you in brown cords. I loved the old office with its 1940s? furnishings. Every staff person you hired has been superb in every way. I love that you thought to get some bilingual Spanish-English speakers into the office. I love that nearly everyone was female and related and felt like a kind person not very different from myself. It was an experience of equality and helpfulness among those who needed help and those who were marvelously able to give the best medical care I will likely ever have. My whole person was seen and joined by people who wanted to help. And I loved that you said in your letter that you wanted to accompany your patients through the big moments in their lives, including their deaths. So, you got me through menopause and my first wedding. For the rest, I expect to sorely miss you.

 Looking for land to build a new home and art studios, we thought of you and your medical center, and realized we did not want to move too far away, that we wanted to have you all the way through our lives. Now we don't, in a sense, know where we want to live, as a good doctor is an anchor in a small community.

As a Kaiser patient for about thirty years, I hated going to the big imposing medical campus. I felt put in my place, controlled, managed, sometimes more like a customer than a patient. I felt Big Medicine glaring down at what might be my future requests for tests and treatments that Big Med could decide to refuse. I did a lot of research because I realized that I would have to manage not only my own health decisions, because the HMO could not be trusted, but I had to inform myself in medical matters for which I have no background. I vented to you about my fear of taking medicines created by a pharmaceutical nightmare that has proved to be the cause of devastating illness and sometimes death when a patient and doctor decide on a prescription that is supposed to promote wellness. Statistically, the percentage is small, but I don't consider myself to be a statistic--and I guess this is the rub. Your advice was to stick as much as possible with older medicines that had not been taken off the market--the newer ones only need a good run of two years to make a fortune--before side effects and legal suits close them down.

I will probably leave Kaiser now, as I hear that the older one gets, the fewer tests and treatments Kaiser allows. At this moment I do not know who my insurance or medical provider will be. I'm looking for recommended persons, not groups or firms or big offices. What we all have learned (I too hated to hear that you couldn't make a living with your wonderful work), is that there are very few independent primary care physicians. One is expected to join a brand that, like other businesses, advertises for market share--a sort of Costco experience of medicine. The caduceus is shamed. If you should somehow decide to stay on with a yearly membership fee for patients, we both would be very happy to contribute. In any case, my thanks for these years, and very best wishes for your happiness and wellbeing,

Mary Webster

My loss, and our community's loss, is a tragedy

Over the course of a chronic problem involving multiple surgeries and chronic pain Dr. Bourne has provided consistent support, respect and sound medical advice. In the 10 years of my need for medical treatment this has been such a rare situation with medical providers that I am heart broken to lose her care.

My loss, and our community's loss, is a tragedy of the current American system. Dr. Bourne's reward for offering true medical care is to lose her practice, her office staff are losing their jobs and her patients are left adrift to fend for themselves in the morass of 'managed care'. I know it can get worse, but this is pretty bad.

Thank you Molly for being a doctor practicing medicine with integrity and compassion. Take good care of yourself. I'll miss you.

Love,
Diane Levy

I had a personal physician

Dear Molly:

I have been a Kaiser member/patient for about 40 years. Kaiser has been a tolerable health care provider. However, they have always delivered minimal and impersonal health care service. You might wonder why I have continued being a Kaiser member. Well, the sorry fact is they are better than most HMO's and/or medical insurance coverage.

Since you became my doctor eight years ago, my entire feeling for Kaiser changed. While, Kaiser has not changed, having you as my doctor has changed my perspective. Now I know that having a doctor who listens, questions, and follows-up is priceless. When I needed to use Kaiser resources, you opened the doors and were my advocate. I felt like I knew my Doctor and she knew me and looked out for my best interest. For the first time in my life, I felt that I was not receiving "fractured" health care. . .I had a personal physician.

I am sad to see you leave our community and sadder yet that I am once again a Kaiser number who might get ten minutes from a Kaiser Doctor when I need medical care.

I applaud you for being an old fashion Doctor who gives patients the time they need and medical follow-up out of concern for their well being. Doctors like yourself are what our health care system is lacking and most of all what I will miss. Thank you for being Doctor Molly! Don't ever change . . . try to make change.

Fondest Regards,
Marie Yvonne Severietti (Bonnie)

I’m frightened and angered