Less invasive techniques (endovascular coiling for brain hemorrhages, port access heart surgeries) are generally concentrated in large urban hospitals. Apparently, this takes place because the patients that require these techniques are more complex and require many specialists available 24/7. The large urban hospitals usually have more specialist available 24/7. Doctors that treat these complex patients often move them to the large urban hospitals. The fact that these less invasive techniques are concentrated in the large urban hospitals means that many patients have to travel great distances to obtain these services. Another way of looking at this is: if you have (for example) a brain hemorrhage and are in a rural area, hundreds of miles from the large urban hospitals, you probably will not get these less invasive services. The surgeons in the hospital that treats you will have to drill into your skull. Assume that we could change, whatever, we need to. What would we need to change to move these techniques to more of the rural hospitals?
One problem with what you propose is that medical personnel need lots of practice to gain & maintain special skills. I would not want a member of my family treated by someone who hardly ever does a procedure. Putting highly trained specialists in a rural setting would not be maximizing a valuable resource.
However, I do understand that when the patient is you or a family member, you want the very best medical resources. A local doctor cannot offer the same expertise available in urban or university hospitals, so he/she can only provide what procedures he/she has been trained to perform.
As a resident in a rural community I have been faced with limited medical choices. When specialized treatment has been necessary, our family has chosen to travel wherever we can find the best resource. On emergencies that has never been more than 5 hours away, & on the two traumatic occasions when time was critical, fortunately helicopters were dispatched to carry family members to a topnotch trauma center. For dentistry & elective treatments I have several times traveled abroad, not only because it was cheaper, but I received much better care than was available here in the U.S. I travel 3,000 miles each way to get new contact lenses because the prescriptions are better there. For anything less than emergency care we can be really good consumers & seek the best for the cost of airline ticket & maybe a motel.
A good medical team includes doctors as well as informed patients & their families. We have a responsibility to become knowledgeable members of this team, & to not only determine what is best for ourselves, but to know how to choose good care & to ask good questions. In your example of a brain hemorrhage, we have to know to ask if there are alternative treatments.
I don’t think rural residents are necessarily shortchanged in medical care. In my experience, local care has been exceptionally good. The one & only pediatrician in our county grew up here, & is so dedicated that she established a foundation to further assist our children. Our primary care provider actually specialized in rural medicine, & was trained to provide excellent care without resorting to unnecessary testing. Our vet actually remembers how much my cats weighed last year & has offered to make house calls because she thought that might be less traumatic for them than being transported to her office.
Do I think these docs are better because they don’t have to carry large patient loads? Yup. Do I think the American medical system could be improved? You betcha, & I also believe that it’s not going to be an easy task. The care of some patients, as in your example, is going to be compromised. Several times over the years members of my family have been advised to undergo procedures that were not as effective or were more invasive than necessary. Fortunately computer access & there is no reason today for anyone to not conduct due diligence on any care provider or procedure. Often there are options if we take the time for a bit of research. Emergencies may limit health care options, but for the most part, for those who have money & good insurance, there is little excuse for not seeking optimal care. Unfortunately for those with limited resources, there are few options. Americans die every day because they cannot afford basic life-saving care. That is truly shameful I had hope during the primaries that someone would take the lead who is devoted to providing universal health care in my lifetime, I don’t even think it’s on the table now. Medical advocates unite!
One problem with what you propose is that medical personnel need lots of practice to gain & maintain special skills. I would not want a member of my family treated by someone who hardly ever does a procedure. Putting highly trained specialists in a rural setting would not be maximizing a valuable resource.
However, I do understand that when the patient is you or a family member, you want the very best medical resources. A local doctor cannot offer the same expertise available in urban or university hospitals, so he/she can only provide what procedures he/she has been trained to perform.
As a resident in a rural community I have been faced with limited medical choices. When specialized treatment has been necessary, our family has chosen to travel wherever we can find the best resource. On emergencies that has never been more than 5 hours away, & on the two traumatic occasions when time was critical, fortunately helicopters were dispatched to carry family members to a topnotch trauma center. For dentistry & elective treatments I have several times traveled abroad, not only because it was cheaper, but I received much better care than was available here in the U.S. I travel 3,000 miles each way to get new contact lenses because the prescriptions are better there. For anything less than emergency care we can be really good consumers & seek the best for the cost of airline ticket & maybe a motel.
A good medical team includes doctors as well as informed patients & their families. We have a responsibility to become knowledgeable members of this team, & to not only determine what is best for ourselves, but to know how to choose good care & to ask good questions. In your example of a brain hemorrhage, we have to know to ask if there are alternative treatments.
I don’t think rural residents are necessarily shortchanged in medical care. In my experience, local care has been exceptionally good. The one & only pediatrician in our county grew up here, & is so dedicated that she established a foundation to further assist our children. Our primary care provider actually specialized in rural medicine, & was trained to provide excellent care without resorting to unnecessary testing. Our vet actually remembers how much my cats weighed last year & has offered to make house calls because she thought that might be less traumatic for them than being transported to her office.
Do I think these docs are better because they don’t have to carry large patient loads? Yup. Do I think the American medical system could be improved? You betcha, & I also believe that it’s not going to be an easy task. The care of some patients, as in your example, is going to be compromised. Several times over the years members of my family have been advised to undergo procedures that were not as effective or were more invasive than necessary. Fortunately computer access & there is no reason today for anyone to not conduct due diligence on any care provider or procedure. Often there are options if we take the time for a bit of research. Emergencies may limit health care options, but for the most part, for those who have money & good insurance, there is little excuse for not seeking optimal care. Unfortunately for those with limited resources, there are few options. Americans die every day because they cannot afford basic life-saving care. That is truly shameful I had hope during the primaries that someone would take the lead who is devoted to providing universal health care in my lifetime, I don’t even think it’s on the table now. Medical advocates unite!
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