Monday, November 21, 2011

Sometimes hospitals make me sick.

This past Friday my mother went in for surgery at UCSF for a specialized operation only performed at elite teaching hospitals. She wouldn't want me to reveal what surgery she had, but she wasn't going to get the care at Mad River Hospital in Arcata or St. Joseph's Hospital in Eureka. She need to come south. Both of the major local hospitals in Humboldt County are just fine for general care, and have made forays into heart surgery and health, but they are well behind in specialty operations and cancer treatment.

It's just a hard reality for most people in out of the way areas; to get advanced medical help they need to travel. This is not the first trip to San Francisco for my family to get medical treatment. We go to tri-monthly appointments for my sister at UCSF's children's hospital to keep control of her type one diabetes (the kind that you are born with and diet changes don't get rid of). None of the doctors in Humboldt are entirely comfortable monitoring my sister's health without the help of specialists in either the Bay Area or Sacramento. Before that my late aunt need to go to Stanford and UCSF hospitals to receive treatment for her brain cancer, as no local doctor on the North Coast would even think of monitoring my aunt, let alone cutting her open.

While making these trips are painful enough, the attitudes of many of the doctors and specialists in the city can be even more excruciating. For example, when one of the doctors released my mother from the hospital he warned her to come back immediately if she started bleeding again as this would be a sign that the operation had failed and needed to be fixed. My father made the offhand comment that he was happy that they'd be staying in Davis with me rather then going home right away in case something did go wrong.

The doctor looked at him quizzically and asked why were they driving all the way out to Davis. My dad informed him that they lived in Arcata, and rather than make the five and a half hour drive up curvy 101, we all decided it'd be best for mom to make the hour and a half drive on straight I-80 to rest a few extra days in Davis before going home for Thanksgiving. The doctor was even more surprised. He had assumed we were locals and would only be a few minutes drive from the hospital rather than hours away.

"You should have just got a hotel room," he replied. Gee, thanks Dr. Personality, we'll just put an additional three night stay on our Platinum card along with the giant bill we're going to get for this little hospital stay. No biggie. I wish I could say that was the only time I heard a doctor in the city say something along those lines to rural patients that have come to the city for treatment. It's an attitude we have to constantly deal with.

Almost every time my sister has to talk to a new doctor in the diabetes clinic, they preach at her how she needs to come to weekly workshops at the hospital. And every time we inform them that my parents, already feeling guilty they can't do everything for their baby, cannot take the time off for an 11 hour round trip for a one hour meet and greet every week.

Luckily there are alternatives open to my family. There are diabetic support groups for my sister to visit with in Humboldt, and the internet is a godsend allowing her to hook up her diabetic meter to the computer to send a weeks worth of readings to her doctors at UCSF in minutes. My aunt was also able to participate in a few cancer support groups when she was still alive. And fortunately my father's physician has agreed to work with my mother's doctors in San Francisco to monitor the progress of her operation.

But these aren't always options open to all rural people. Trinity County has only one "medical center" to service over 3,000 miles of territory, to service less than 14,000 people. Funding that medical center has been a real problem. Areas don't have enough patients of certain types to have support groups, or if they did, the patients are too spread out to meet regularly with each other. And being able to make regular trips to places like San Francisco? Not easy.

This is just one of many problems of living in less accessible areas. It is a royal pain when medical professionals don't take a sympathetic approach to their patients from the boondocks. But it's a pain we'll probably have to put up with for quite awhile.

Related Posts:

Legal Ruralism: Mercy Mount Shasta to close skilled nursing facility

Legal Ruralism: Improvements to rural medicine?

Legal Ruralism: Obamacare's implications on the southern Oregon coast


KevinN said...

I have several relatives who live in rural Nevada that have faced similar issues. The hospitals in their hometowns are sufficient if you need a few stitches or some other type of general care, but for anything more advanced, it is necessary to travel to one of the major population hubs for treatment. One family in particular has had to move to Reno for the foreseeable future while dealing with an extended illness. I think the lack of quality healthcare is one of the biggest issues facing rural areas. As rural populations continue to age and necessarily require more advanced healthcare, they are often left with one of two options: relocate or commute to a bigger city for the length of time it takes to treat the problem or try to make the best of it with the often sub-standard care and equipment available at home. I'm not sure that there's really any good solution to the problem. It would require a huge number of doctors and an incredible investment in infrastructure in order to assure that all Americans have access to the same level of healthcare. That simply isn't feasible. However I do think that the internet is an underutilized resource. As you mentioned in your post, the internet can provide a wealth of information and allow patients to connect with one another to discuss their health. It can also be better utilized to connect specialists with people living in rural places. Oftentimes doctors simply check over numbers from lab results and discuss the course of treatment with the patient during their appointment. There is little to no need for physical contact or proximity. In those cases, some sort of video conferencing or telecommunications system would enable the patient to receive advice and treatment from doctors in bigger cities without having to leave home. And as you illustrated, the cost of travel combined with the cost of medical treatment can often be overly burdensome. The cost of a high-speed internet connection on the other hand is much cheaper.

Courtney Taylor said...

I think this post highlights issues in our healthcare infrastructure that affect rural communities as well as urban ones. While I wholeheartedly agree that the travel and expense required for specialized healthcare places an unacceptable burden on rural people, I think it's important to note that this burden can also affect urban-dwellers. There surely are people who live in Southern California cities who are diagnosed with rare illnesses that can only be treated at Stanford Medical Center, for example. They are required, just as rural people are, to travel long distances to receive treatment.

I think there are solutions, however, that can benefit both rural and urban patients. As you and Kevin point out, the Internet is a great tool for transmitting data between hospitals to reduce the number of in-person visits that are needed. Although this is used in some hospitals, it is not used nearly as much as it could be. Using the Internet for virtual patient care will require a huge culture shift for today's doctors. Perhaps as people in medical school now begin their residencies, they will be more open to working with patients and their local doctors over the Internet.

JT said...

I'm sorry to hear about your mother's trip to the hospital and even more sorry that the doctor wasn't particularly understanding. As both Kevin and Courtney have pointed out, online consultations or treatment services are definitely an underutilized source in facilitating rural access to medical care. A family friend similarly had to make quite a trek to the Stanford Medical Center for treatment exclusively offered there. In fact, the medical issue was such an emergency they had to fly him there -- needless to say, the bill was extremely costly and I am sure medical expenses are bound to pose another issue for many others. While I share your surprise at the doctor's seeming ignorance of deficit medical resources in rural areas, I wonder if informing them of the gravity of the problem would benefit? Policymakers and governmental actors might be the ones determining allocation of funds and resources, but a doctor's opinion on the matter could hold more sway.

Jason said...

I'll echo what others have said, but it seems as online consultations are the fix for rural patients. This opens up additional problems in terms of rural resources to adequate technology, cost of the visit and whether it is necessary to have the specialist assisted by an onsite consultant, etc.? No doubt our technology is often more advanced than we understand and we often fail to utilize it to its full potential. However I feel this is an area where everyone can see the potential and are actively working towards a solution.

In reference to the other problems that may arise, they will most likely raise the initial cost of such "visits" and check-ups, but with time will decrease and provide better medical care to rural inhabitants.

oceguera said...

Unfortunately, cultural insensitivity runs rampant in medical industry. My partner works in health care and tells me absurd stories of how patients get treated. It is ridiculous to see the amount of medical service providers casting judgements on those they are supposed to serve. I myself have experienced insensitivity around gender and sexuality issues by my primary-care provider at UC Davis (!). Every time I interact with my dr, I am shocked to hear the(stereotypical) comments and general assumptions they make about me. One would think in a place like Davis or San Francisco, health care service providers would be more open and less judgmental about their patients.