World Without House Calls
As a child growing up in rural Virginia 25 years ago, I had
the privilege of living in an era of country doctors who grew old along with
the communities they served. It is an era that has largely passed, and the
fact that I have maintained the same family physician as a resident of one
of Virginiaís most isolated counties for the past six years is nothing
short of remarkable. And necessary, I think, for my good health and the
health of my family.
Nevertheless, I still live in one of 36
Virginia counties that are considered medically underserved, according to
the Virginia Department of Healthís Office of Health Policy and Planning.
Even more areas, particularly rural ones, suffer from shortages of
primary-care providers. But itís not just the number of health-care
providers that is going down in rural areas.
Quality of care is another issue. Rural
residents who were once accustomed to doctors who could name all their
patientsí grandchildren have trouble adjusting to young,
fresh-out-of-med-school doctors who perform two-year stints in rural health
clinics and then move on, or to long drives to the city where they receive
substandard care from providers who see hundreds of patients a day and
canít distinguish one from another.
My familyís doctor has served pancakes
with me at the local maple festival, chowed down hot dogs with me at Ruritan
Club picnics, and even backed into my car with his Jeep. You may wonder why
this matters. I didnít think it did until I was expecting my first child
and was exposed to a cadrť of health-care professionals who not only had
never had a friendly fender-bender with me, but didnít have the slightest
clue who I was and really didnít care.
It started when I sought care from a
group of certified professional midwives, thinking I would have more
personalized attention from a midwife than an obstetrician. I was wrong.
Every time I had a prenatal-care appointment, I got shifted among four
different midwives. I was told this was necessary because any one of the
four might be on call when I was in labor, and surely I wouldnít want a
complete stranger delivering my baby? As if a woman exhausted by 31 hours of
labor would care who is on the receiving end.
What I cared about was who was going to
walk me through my first experience of pregnancy and motherhood. As it
turned out, no one in particular. Every time I visited, I had to explain to
a different midwife why I lived 68 miles away, why my husband was away
overseas, why I was self-employed, and why I was fixing fence in 90-degree
heat or shoveling gravel on the driveway when I should be ďtaking it
easy.Ē Somehow I doubt my general practitioner in Highland County, who
himself lives on a mountaintop in the middle of nowhere, would have been
asking me any of these questions.
The fact is health-care professionals in
more urbanized areas, besides providing cattle-chute care to one more
patient in the barnyard, have very little grasp of the unique issues facing
rural residents, one of which is transportation. When I was at eight months,
my midwives required me to come over the mountains at least once a week for
a five-minute appointment. These trips entailed taking nearly an entire day
off work, a three- to four-hour roundtrip drive, and usually at least an
hour-long wait at the midwivesí office. One day it entailed a two-hour
wait, and when I got up to complain, the receptionist told me they were
running behind and could I come back the next day? I was livid, and I told
the office staff Iíd call them when I was in labor. Which is pretty much
how it happened.
Things were no better once my daughter
was born. After more than 30 hours in labor, hospital staff harassed me
nearly once an hour for the remaining 48 hours of my stay, including 3 a.m.
blood-pressure checks and dinner menu requests (as if it mattered when even
the Salisbury steak tasted like Jell-o). When the stress of temporary single
parenthood and returning to work four days after my daughterís birth kept
me from sleeping for weeks on end, postnatal-care providers strung me along
for three months with lame suggestions that perhaps I was suffering from
sleep apnea or needed to drink more chamomile tea. It took my family doctor
to set things right with something as simple as a prescription for sleeping
I was a victim of getting lost in the
shuffle. And Iíd seen it before. Several years ago, my father found
himself suffering from chronic chest pain. For five years, he was taking
regular trips to the hospital in Charlottesville in the middle of the night,
fearful of heart trouble. For five years, heart specialists sent him home
with pills for heartburn. Finally, my dadís general practitioner, a rural
doctor whose children had been students in my motherís English classes and
played in the marching band with me when I was a teenager, put his foot down
and demanded that Dad receive a catheterization. The result? Dad had a
blockage in one of the arteries leading to his heart. To this day, I believe
my parentsí family doctor saved my fatherís life. My dad was lucky to
have an advocate.
But as outrageous insurance costs and in≠creasing
regulations drive small-town doctors out of business, fewer and fewer of us
have advocates. A couple of years ago, my uncle, a small-town dentist, was
forced into early retirement because he couldnít afford to meet these
rising costs. Hundreds of senior citizens,
who had benefited from his low rates and sometimes acceptance of
produce in exchange for a teeth-cleaning, no longer have oral care.
With insurance companies ruling
Americaís health-care roost, we shouldnít expect the situation to get
any better. And while tele-medicine promises to give a lot of rural
residents access to care they might not otherwise have, just how good a
diagnosis can a doctor give to a person he has never met?
If the registered nurse in Harrisonburg
who told a lone mother with a one-month-old ó 120 miles from her closest
family member or friend, with editorial deadlines looming and no time to
even eat, much less sleep ó to soothe her insomnia with a cup of chamomile
tea is any indication, the prospects donít look good.
Fortunately, my family doctor (who
happily gives out his cell phone number to patients and will call at 9 p.m.
just to make sure the cereal/infant-formula mixture he recommended is
working for my daughterís stomach troubles while asking quickly after my
dadís chest pain, even though my dad isnít his patient), has a
three-year contract left here in Highland.
What happens after that, or what happens to the rest of rural
Virginians who donít even have a doctor, is anybodyís guess.
Presidential candidates can promise access to health insurance for every
American till theyíre blue in the face. What they canít promise,
however, is access to quality care.