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The Agent of Change: Josh Cook 

Local hero and doctor from Prineville, Josh Cook sets out to transform the health care system.

In many ways Josh Cook is an unlikely candidate to transform America's moribund health care system

An emergency room physician, Cook set out to be a teacher only to find himself practicing medicine despite the fact that he never completed his undergraduate degree - it wasn't required for him to be accepted into medical school.

"To me it was a much shorter and direct way to being a teacher."

Instead of teaching, he found himself practicing family medicine as a doctor of osteopathy, a more traditional practice that emphasizes hands on medicine and direct contact with patients.

Within a few years, Cook made his way to the emergency room and in doing so found his niche. It's where Cook has been for the past 20 or so years, tending to broken bones, delivering babies, treating cardiac cases, performing emergency surgery on car accident victims and everything else that comes with the day-to-day reality of the ER. For the last decade and a half Cook has been the face of emergency room medicine in Prineville where he has served as the both the chief of staff at the Prineville hospital and the emergency room director, overseeing a staff of 12 physicians that covers emergency medical duties in both Redmond and Prinevillle.

"There's no rhyme or reason. I practice in Prineville so it's a relatively low volume, but we can have huge surges."

Because pain and suffering, death and disease don't take a break, Cook can be on duty day or night any day of the week, 365 days a year. In recent years, though, Cook has switched from focusing solely on patients and turned a fair amount of his attention to treating the ailing medical system, which he, like so many other, caregivers sees as failing the American public. Recently, Cook has found himself on the forefront of the health care overhaul debate, largely because of the work he and other care providers have done in Prineville where Cook has helped to lead an intiative aimed at expanding health care access to the entire population. The work is still in its nascent stages, and is funded largely by a federal grant, but early indications are showing some promising results that could have implications for the region, the state and the nation.

Recently, Cook joined the St. Charles Board of Directors. His goal is to represent the needs of the rural population that he has tended to as an ER physician and medical director, but also to share the lessons that he has gleaned on the forefront of the health care revolution that he believes is already underway.

"The real mission that's happening is we have to transform health care and that's where my passion is at this point. How can we go from this system that is unaffordable for the individuals, for businesses, for the state and for the country into something that works and provide better medicine. That's now a focus of everything were doing here."

St. Charles CEO Jim Diegel said it was Cook's dual experience as a physician and an administrator who started the first federally qualified health care clinic in Central Clinic, the Mosaic Medical Clinic in Prinville that made him attractive as a board member.

"I watched him blossom as a leader in Prineville then become involved in some of the regional work. And when we asked Josh to join the board we weren't asking Dr. Josh Cook, we asked Josh Cook the community leader to join us," Diegel said.

Regardless, Cook's views on the changing nature of health care is informed by his two decades as a physician in the emergency room, a place that he speaks of with affinity, but also refers to as the dumping ground for the health care industry.

"If there's any take home message, it's that the bulk of medicine that is practiced in the emergency room department should not be practiced in the emergency room department."

But getting people out of the ER into the local doctor's office takes a seismic shift in health care delivery, which is based on a demand-for-services model. And most patients only demand the services when they need them most, long after the optimal window for intervention has closed. Consider, says Cook, that the number one, the Number One!, diagnosis in the Prineville ER was acute mouth pain. That means that not only has the patient ignored all the warning signs of dental decay, but he or she has actually come the wrong place for treatment. Prineville now works with a dental group to refer these patients to a dental provider for treatment. More importantly though, Cook and other care providers have developed a system for identifying these patients earlier, before they become a huge financial burden on the system. And they are a huge burden. Consider that 80 percent of all health care dollars is spent on 20 percent of the population and you get a sense of just how out of whack the system is.

Those dynamics create a huge economic incentive for doctors, patients, politicians and the general public to fix the current model. However, Cook says that we ought not look to Washington for answers to the dilemma. Rather, the solution, or solutions, have to be developed at home, in clinics, emergency rooms and board rooms here in Central Oregon. Thanks to Cook, we have someone to start. Right over in Prineville.

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