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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