Wednesday, March 30, 2016

“You Can’t Always Get What You Want, but If You Try Sometimes…” – Part One: Some Thoughts on the Assets and Liabilities of Small-Town Medicine (Part Two Examines the Parallels to Small-Church Spirituality)

The allure is undeniable: larger communities with larger healthcare systems certainly appear to operate in a more professional and business-like manner than elsewhere. Likewise, the apparent benefits of churches with memberships larger than the entire population of the Fall River Valley seem unquestionable, at least for those who can afford the time and gas money to go where the band is more talented, the preacher is more polished, and the coffee bar better stocked. But while there are liabilities inherent in both small-town medicine and small-church spirituality, certain assets in each suggest that there may be important reasons to “shop local” for both your physical and spiritual care. The parallels I see in small-church spirituality will follow in part two. For now, here are my thoughts in support of patronizing the resources available in small-town medicine.

A Geographic Snapshot: Rural Medicine and the Time-Space Continuum
My wife and I work full-time. We also volunteer for a number of organizations (including our employers). We choose to invest in our community in a variety of ways, some of which take us to some of the more remote residences tucked away here in the mountains of northern California. As one result, our busy schedule and our commitment to “shop local” leads us to seek most of our routine health-care here in the communities of our low density population area. Amidst the 1200 square miles of The Intermountain Area, there are three clinics, spaced evenly apart along the highway that runs through the communities of Bieber, Fall River Mills, and Burney. There are even two pharmacies from which to choose, although these are less than a mile from each other at the southwestern end of the area in Burney. At times there has been a third, more centrally located in Fall River Mills very near the area’s only hospital. Sadly, those attracted by the “convenience” and “low-low-prices” of mail-order drug suppliers overlook a number of factors. Not only is there the inconvenience of a long drive to pick up their occasional antibiotics or other urgently-needed medications, but there are also the dangers inherent in circumventing our local pharmacists’ ability to compare multiple prescriptions for potential interactions.

A Sociological Snapshot: Rural Medicine and Being Our Brothers’ Keeper
These are the kinds of cost-benefit decisions we face in our community. What the British would say is “penny-wise and pound-foolish” translates here to more directly “biting the hand that heals you.” The declining availability of quality assets in our local community are not always a matter of mere convenience. Most in our area cannot afford the luxurious options enjoyed by wealthier community members. Certain leaders have noted that the presence of a hospital matters more to their property values than their healthcare decisions. (“People won’t move here if there isn’t a hospital. But if you can afford to move here, you can afford get your healthcare in Redding.”) One hospital board member has offered that he sees the facilities existing only for a very short list of urgently necessary services. The time and expense of pursuing care elsewhere, though, is nearly impossible for many who are less-mobile than our more affluent retirees. Whether due to time-consuming work schedules or the limitations of insufficient gas-money (or both), the majority of our residents in the Intermountain Area are dependent upon quality healthcare being provided through the single chain of clinics, the only hospital, or the two pharmacies located within just one mile of each other.

An Anthropological Snapshot: Rural Medicine and the Consequences of Inattention to Detail
Thankfully, so far, the quality of healthcare available is still amazingly high, especially when compared with the relatively low quantity of our private-pay population who choose to support them. Unfortunately, though, the strain is beginning to show. The internal matters of staffing and scheduling, no doubt, inflict great difficulties upon the dedicated individuals and teams who make possible the practice of medicine in our midst. My perspective here, however, is from that of the patient—the one who depends upon available medical assistance, accurate diagnosis, and accessible treatments, including the appropriate medications. Some recent experiences have highlighted distinct deficiencies in the system.

Twice now, in our immediate family, prescriptions have been written on the wrong forms, and once by personnel not legally permitted to do so. The most recent episode was compounded by neither local pharmacy having enough of the given medications available to fill two of three prescriptions. Further hindering the process of getting a sick patient to their home (half an hour away), the pharmacy that had a partial amount to fill one of the prescriptions had none of the patient’s information on file. Worse, in another half hour of computer and phone contacts, they eventually determined that they would be unsuccessful in securing payment from the patient’s insurance. Of course, then, the insurance company balked at reimbursing the full retail price that was paid “out-of-pocket.” But there seemed to be no alternative. After two trips to the clinic (having returned to get the properly formatted prescription), two to the first pharmacy (which found the prescription to be incorrectly written), and two to the second pharmacy (after confirming with the patient that they had no other insurance documentation with them), it was nearing closing time for all of the above. If there had not been a credit card handy, we may have failed to get the medications considered “essential” to the patient’s recovery.

These are not uncommon obstacles to our community’s pursuit of healthcare. Other patients have been hindered from health by even greater difficulties resulting from insufficient inventories. Some are dissuaded from seeking care by the confusing double-billing practice of both locally invoicing and simultaneously outsourcing the same charges to our hospital’s “not a collections-agency.” On occasion, overworked hospital personnel have failed to appreciate how easily patients overhear the staff’s crude and cruel comments about their diagnoses and treatments. And then, there are those times when it seems that other distractions take priority over the delivery of healthcare by the employees of our healthcare system. For example, one night, seeking to have blood drawn by the lab at the local hospital (as my physician had directed), I waited over an hour while my fever continued to rise (101.1 to 102.7) because the receptionist was unwilling to call the on-call laboratory tech. Only after an intervention by the health clinic’s on-call nurse were the doctor’s orders followed. To be fair, in defense of the receptionist’s otherwise inexcusable procrastination, there seemed to be ample reason for her anxiety, given the lab tech’s mood when eventually arriving to tend to a paying customer’s needs.

A Moral Snapshot: Rural Medicine and the Blessings of Personal Investment
And then, there’s Melissa, the Pharmacy Tech (labelled thus so as to differentiate her, as we did in our fan mail to the pharmacy’s corporate offices, from Melissa the cashier, who I’m sure is perfectly wonderful as well). After our first trip to the first pharmacy, trying to get the right medication for the correct prescription on the wrong form, we were back for our second visit to the clinic, to get the prescription corrected. Even before I arrived at the front desk of the clinic, Melissa was there beside me. After we had left the pharmacy, the pharmacist had pointed out to her that whether we had the prescription on the correct form or not…they didn’t have the medication in stock. So, Melissa called the clinic to intercept us, except that the receptionist was momentarily away from the desk, so the voice-mail kicked in, telling Melissa that the clinic was closed for the day. Because her car was parked in the opposite direction, she decided it was safer to simply run to the clinic, so that we did not find the closed, and return to Fall River Mills in despair.

And this is where Katelyn comes in. Granted, she was away from the desk momentarily. But I believe she’s not the one responsible for the wrong voice-mail message being loaded. In any case, she and Melissa consulted and confirmed that the medication that was available had already been tried and found ineffective. They then phoned the other pharmacy, sharing the phone to confirm that the competitor to Melissa’s employer had at least a partial supply for the patient’s need. But the partial supply would “use up” the full prescription, so yet a third prescription for the same medication needed to be written…and it was, thanks to Katelyn’s willingness to contact another healthcare professional with the credentials to make it happen.

To clarify my pessimistic perceptions for you: there can be a tendency to ignore our mutual responsibilities for one another, whether divided into the categories of staff and patients, or divided into those who must rely on local providers and those who can afford to seek healthcare elsewhere (which ironically includes some of those who accept the obligation to maintain the local resources for others). Those who seek their own convenience, sometimes to the point of refusing to inconvenience themselves for the sake of others, put the health and well-being of patients (“paying customers”) in jeopardy.

Despite my pessimism that suggests that dwindling attention will result in resources dwindling even further, my flickering hope is occasionally fanned into a few ember-fed sparks. It is not just Melissa and Katelyn, though they certainly served that purpose most recently. But there are still more than a mere handful who recognize the priorities of patients as the core commodity that will either sustain our healthcare system, or allow it to implode once it is hollowed by a continued decline in attention to the needs of those patients.

Which will it be? As promised, the same question applies to small-church spirituality as well, and we will turn to that application in the next post.

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