Monday, October 12, 2009

A health care story that defies some rural stereotypes, confirms others

A story on NPR this morning ran under the headline, "How the Modern Patient Drives up Health Care Costs" so I was surprised when the composite "modern patient" referred to turned out to be that of rural physician Teresa Moore of Keysville, Virginia, population 817. After all, aren't rural and modern inconsistent? Maybe not in the Internet age. Here's an excerpt that reflects both rural stasis and rural change:

Moore's family practice is in Keysville Va., the same small community where she grew up. Her patients are people who attended her baptism and helped at her wedding. So in some ways, Moore has a true old-timey medical practice. But in one important way, her practice is completely different:

Moore cares for modern patients. They're the people who come in with specific requests for medications and procedures. And oftentimes they get what they ask for, whether they need it or not. This consumer-driven health care is part of what's driving up costs across the country.

In our Law and Rural Livelihoods class and on this blog, we've discussed rural access to broadband and its economic and cultural implications. Well, lots of rural places don't have broadband, but apparently Keysville does. Here's what wikipedia says on the matter:

An Optical Fiber link between Farmville, Virginia and Keysville, Virginia was the first on the agenda in efforts by Governor Mark Warner to bring broadband internet access to rural areas of Virginia, funded by the Tobacco Idemnification fund. This was also accomplished to aide in developing the Southside Industrial Park by bringing mid-sized businesses the technological access needed in an effort to bring more industry to Charlotte County. The link is complete but has yet to be utilized.

So, industry in Charlotte County, Virginia, may not be using that optical fiber link, but Moore's comments suggest that her patients have sufficient Internet access to make them "informed"--actually, sometimes misinformed:

The problem, says Moore, is that it can take a lot of work to convince her patients that their own diagnosis is wrong. More accurately, it takes a lot of work with her younger patients.

"In the older population, there is a tremendously different dynamic," Moore says. "There's a lot more belief and trust in doctors." But not in younger patients. "In patients between 25 and 50," she says, "there is a lot more push to get what they want."

Not only are rural patients informed by the same sources we would assume inform urban patients, but they are also assertive--at least the younger ones and at least with regard to health care.

Listen to the first in this NPR series on "Doctors Decisions," which aired last week, here. The headline is "The Telltale Wombs of Lewiston, Maine." Lewiston's current population is 35,690, and it is part of the Lewiston-Auburn metropolitan area. Yet that story, too, has a rural angle--essentially how lack of anonymity among medical professionals in a limited market influences treatment norms. Plus, it references a 1970s study of various places in Maine and Vermont, which were then more rural. Here's an excerpt:

Then there was the role of local medical culture. For example, even though it didn't make sense and wasted a lot of time and money, pediatricians in some communities felt they absolutely positively had to send even mildly sick kids to the hospital.

"Families in small Maine communities were used to the fact that if their kid had a temperature of 102 and was vomiting, that kid was going into the hospital," says Keller. "They'd been doing it for years, so they'd be aghast if they took little Tommy down and he had a temperature of 102 and the doctor said, 'Well, go home and take this.' Nobody did that!"

It was probably safer and better all around not to put the kids in the hospital, and the doctors knew this. But doctors, like the rest of us, are people, and therefore are subject to subtle influences.

Listen to the rest here.

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