tag:blogger.com,1999:blog-714028479313834812.post223179946726007649..comments2024-03-28T11:58:42.109-07:00Comments on Raconteur Report: NYT Shocked: Rural Means Not Big CityAesophttp://www.blogger.com/profile/07834464741531503378noreply@blogger.comBlogger23125tag:blogger.com,1999:blog-714028479313834812.post-50358228418046138832018-10-30T19:37:41.080-07:002018-10-30T19:37:41.080-07:00Here is another issue, back in the 70's Hospit...Here is another issue, back in the 70's Hospitals starting changing from non-profits and Insurance companies from mutual formats. Local control and focus on providing service instead of profits sent to Wall Street was lost. For that thank the lobby people (lawyers) and their supporters. At that point the only things big enough to fight back was state and federal governments. We all know the result of that. The rural hospital has to be a primary care facility with the ability to call upon and integrate with the larger center city facility as several above have mentioned.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-90977115888330839292018-10-30T16:12:42.178-07:002018-10-30T16:12:42.178-07:0025 years ago, I was reading stories about small ru...25 years ago, I was reading stories about small rural hospitals along the US/Mexico border closing due to foreigners (read illegal aliens) coming across the border for their medical needs, then boogieing back across without paying their bill (who knew THAT would happen). So this isn't new news, except that now the "problem" is being recognized because it's happening all over the country, as illegals and other foreigners (refugees) are being spread all over the country in resettlement programs funded by our tax dollars and other non-government do-gooder programs.<br /><br />NemoAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-48720168159692955202018-10-30T13:31:15.570-07:002018-10-30T13:31:15.570-07:00Ah, staying true to form. Good to hear!Ah, staying true to form. Good to hear!TiredPoorHuddled Masseshttps://www.blogger.com/profile/18020593677167274851noreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-77582311904766936782018-10-30T11:34:53.634-07:002018-10-30T11:34:53.634-07:00But cleverly still manages to draw most of the wro...But cleverly still manages to draw most of the wrong conclusions.Aesophttps://www.blogger.com/profile/07834464741531503378noreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-76068638320606026312018-10-30T11:20:02.007-07:002018-10-30T11:20:02.007-07:00A NY Times article that gets the facts straight? W...A NY Times article that gets the facts straight? What is the world coming to?TiredPoorHuddled Masseshttps://www.blogger.com/profile/18020593677167274851noreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-16476684593315347192018-10-30T11:12:31.741-07:002018-10-30T11:12:31.741-07:00Aesop,
"10K-20K is rural.
Smaller than that,...Aesop,<br /><br />"10K-20K is rural.<br />Smaller than that, is, in fact, Beyond The Black Stump, aka BFEgypt."<br /><br />Until recently, for 20+ years we lived in a 1500 sq mile county with 3,000. And you could have barely accumulated 10k by adding the next two contiguous counties. And that is not an anomaly in this neck o'.<br /><br />Even now our environment is just barely 10-12k except when the Communist FOB (college) is in session. <br /><br />After I wrote this I had to hit the reCaptcha thing, and it had me identify all the traffic lights. That reminded me that the first county I mentioned had Not. Even. One.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-34199948183360575432018-10-30T10:09:15.619-07:002018-10-30T10:09:15.619-07:00@ Gray Man
In many instances of people calling the...@ Gray Man<br />In many instances of people calling the ER elsewhere you may be right but here it wasn't the case. The ER physician in question was incompetent, incredibly rude to patients and families bordering on abusive. The other staff detested him and he treated nurses and the EMT crews like they were beneath contempt. In a small rural area word spreads fast. Everybody either had a story about him or could tell you several they'd heard. My experience with him was certainly consistent with the stories going around about him.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-71845919308975180532018-10-30T09:36:10.199-07:002018-10-30T09:36:10.199-07:00"Quality over quantity, any day, any time. &q..."Quality over quantity, any day, any time. "<br /><br />Yes, well said. I would expect that, once reaching the 7th decade of life, our chief occupation should be to prepare for our certain demise, and to understand the event should be with a bit of dignity and acceptance...and avoidance of heroic and very expensive attempts at maintenance.elysianfieldhttps://www.blogger.com/profile/03455259748394485019noreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-42174591881152967442018-10-30T09:17:44.914-07:002018-10-30T09:17:44.914-07:00I live smack dab in between two rural towns of abo...I live smack dab in between two rural towns of about 14k population a piece. Both of them have hospitals. One of them has an ER with a CT scan available, I know that much from being through it. Neither hospital is like where I grew up, but I also like the fact that neither hospital has waiting rooms in the ER jam-packed with 50 people at any given moment (see: Stanford). <br /><br />One of the rural communities is a well-known place for fairly wealthy retirees, so they have an excellent stroke and cardiac unit. In worst cases, a flight to Sacramento (Mercy General, etc.) is about 15 minutes. I still have a couple of specialists in the Bay that I see twice a year, and one of them is nearly convinced to move up here (same health care system, and it's better up here in terms of lifestyle). I do NOT miss living in an urban environment, I never will. <br /><br />Hell, if I croak on my patio from a heart attack, it'll be while while listening to the frogs in my pond, the crickets chirping, looking at the gorgeous scenery, and feeling content (minus the chest pain for a bit). MUCH worse ways to go. If they want me moving back to the Bay or some other hellhole, they can think again. A life well-lived and content, even if somewhat shortened, is better to me than a long life filled with sirens, crime, assholes, traffic, craptastic water, and scenery composed of nothing but buildings that look like someone shat out a Lego. Quality over quantity, any day, any time. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-47967173084888247252018-10-30T08:44:56.202-07:002018-10-30T08:44:56.202-07:00Yes, it is indeed Bardstown.
I grabbed that pic be...Yes, it is indeed Bardstown.<br />I grabbed that pic because it's photogenic small-town America.<br /><br />@Gray-Man<br />10K-20K is rural.<br />Smaller than that, is, in fact, Beyond The Black Stump, aka BFEgypt.Aesophttps://www.blogger.com/profile/07834464741531503378noreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-13417423762344406742018-10-30T06:45:31.709-07:002018-10-30T06:45:31.709-07:00Uh....that's my hometown mainstreet in the pic...Uh....that's my hometown mainstreet in the picture, Bardstown, KY. We have an excellent community hospital, Flaget Memorial. And, if needed, its about 35 miles from Louisville, and about 50 from Lexington. I think Bardstown is now about 20K. When I grew up there it was about 6K. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-75142768657144264382018-10-30T04:03:29.955-07:002018-10-30T04:03:29.955-07:00Saw a story during the weekend, talking of drones ...Saw a story during the weekend, talking of drones delivering medical supplies to remote areas faster than standard vehicles. No where near the quantity of course (Story mentioned 10 pounds with the current drones used) were the norm. Flyzipline is one such service.<br /><br />http://www.flyzipline.com/<br /><br />No idea on what their range is but that is a good idea, I think.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-81703120345756994792018-10-30T02:28:27.559-07:002018-10-30T02:28:27.559-07:00I notice commenters referencing "rural" ...I notice commenters referencing "rural" hospitals in towns of 10k and 20k. Damn. If that's rural, I must be on the damn moon.The Gray Manhttps://www.blogger.com/profile/15098168056466325559noreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-69991384662654641092018-10-30T02:25:11.364-07:002018-10-30T02:25:11.364-07:00I assure you that the vast majority of people call...I assure you that the vast majority of people calling to see who the doc on call is, are not calling because they have a legitimate issue. 98% of them are calling because they want to make sure that the right doc is on, the one who'll give them 2mg of Dilaudid and 50mg of Phenergan for their chronic body aches.<br /><br />Ask me how I know.<br /><br />Actually, don't. You either already understand, or you're one of them.The Gray Manhttps://www.blogger.com/profile/15098168056466325559noreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-87461414689806744222018-10-30T02:21:13.111-07:002018-10-30T02:21:13.111-07:00Is a city of 10k really considered "rural&quo...Is a city of 10k really considered "rural"? Just wondering.The Gray Manhttps://www.blogger.com/profile/15098168056466325559noreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-29140498337779610902018-10-30T02:18:48.168-07:002018-10-30T02:18:48.168-07:00As a RN splitting my time between a Level II traum...As a RN splitting my time between a Level II trauma center in a city of 55k, and a rural hospital in a town of about 300 (where I live), I agree with all of your points, except maybe your estimate of requisite population numbers in order to support a hospital that can offer "everything".<br /><br />As far as rural ERs, a LOT of what we can and can not receive hinges on whether or not we have a CT available 24/7 (we do) and whether we can administer tPA (we can).<br /><br />All I can say is thank God for LifeFlight and ShandsCair.The Gray Manhttps://www.blogger.com/profile/15098168056466325559noreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-65184912545333272562018-10-29T21:18:00.843-07:002018-10-29T21:18:00.843-07:00>you can't have an ICU in Podunk, because i...>you can't have an ICU in Podunk, because it'll either be empty, or overflowing<br /><br />And let's generalize this a little more to not just ICUs but cardiac catheterization labs and the like: Another problem is that if volume is low, a local practionner may not have enough cases to keep his skill level high. If you're getting a complex coronary procedure done, you want the guy who does 3-5 tough cases a day, not the guy who does three run-of-the-mill cases a week. Or a month.<br /><br />> If a certain physician was on duty people drove an hour to somewhere else<br /><br />Oh yes. And it's not just the ER. Same with inpatient attendings, only most people don't have access to the info, and can't influence how the system works. Example: when my mom was seriously sick and admitted to hospital via Emergency (at the place where I did my Medicine residency so I knew folks) my question to the ER attending (with whom I was on good terms) was, "Who's on for Gen Med?" <br />ER Doc: Lemme see ... Oh, it's McBraggart's team.<br />MC: Shit.<br />ERD: Yeah, shit. Good ol' Florid McBraggart, bless his useless ass. Hmmm. It's 1430, when does Medicine switch from short to long call again?<br />MC: Three PM.<br />ERD: Tell you what, I'm gonna hold off on putting through the admission order for about 31 minutes.<br />And so it went.<br /><br />>Your survival for cardio events is probably far more dependent upon the time that spins off the clock between first symptoms noticed and first molecules of anticoagulant in the blood stream<br /><br />Yeah, mostly. On the other hand, there is an alternative to having to use TPA ("clot buster") because of remoteness. In places such as where I'm sitting right now, we have 24/7 interventional teams (that will go in and open up that coronary artery and stent the fucker) at literally 4 hospitals within 2 miles of here. NOT the usual state of the country I admit, but I'd point to the Minnesota system as an example. In MN ANY rural hospital in the state can "activate the cath lab" at the main University Hospital in Minneapolis. As they're bringing in the interventional cardiologist and his team in Minneapolis, in Bumfuck the patient is being put in ambulance, on helicopter, or on fixed-wing craft (depending on distance to Minneapolis) emergently to the Univ Hosp. This is effective because it prevents the problem of complex and expensive labs and equipment that will mostly be underutilized at Rural Clinic (and not having it there prevents it from being used unnecessarily). It also allows each patient to be treated by doctors who have HIGH case volume and expertise. The key is that Univ Hosp has to trust that Rural ER is not sending them false alarms.<br />Mike_Cnoreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-45222998286986504192018-10-29T20:29:06.147-07:002018-10-29T20:29:06.147-07:00My next door neighbor had a bout of kidney stones....My next door neighbor had a bout of kidney stones. The first bout had him sitting in the Sparrow Hospital waiting room as it filled up with homeless people with "chest pains" on that cold night. It was eight hours before he triaged to the top.<br /><br />The next time he had kidney stones passing, admittedly not a high mortality event, he went to the small town hospital. In five minutes he was in a private room. In fifteen he had an IV and was in happy-land.<br /><br />His words were "I would rather die in the Eaton Rapids hospital than spend another minute in Sparrow's emergency room."<br /><br />ERHC and Hayes-Green-Beech in Charlotte cannot do heart surgery but they can diagnose and smack you with drain-o-for-the-brain-o, box you up and ship you out. Your survival for cardio events is probably far more dependent upon the time that spins off the clock between first symptoms noticed and first molecules of anticoagulant in the blood stream than it is dependent on how many ICU beds are under the roof.<br /><br />It is an additional bonus that the bacteria in the drains are naive, the nurses are young and pretty and the floor staff will allow your wife to bring your dog to visit you.Eaton Rapids Joehttps://www.blogger.com/profile/09102166969915526172noreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-33535638783097511242018-10-29T20:03:13.187-07:002018-10-29T20:03:13.187-07:00Klamath county in south central Oregon has one hos...Klamath county in south central Oregon has one hospital in a city of 20,000. It had a horrible reputation ("Merle West" turned into Murder West.) It seems to be a bit better as Sky Lakes (Sky Flakes) for basic stuff, with cardiac care up through pacemakers. Our population is pretty old; we're where the not-so wealthy Californians do a CalExit. Medium bad trauma is a 100-150 mile flight to Medford or Bend, with really bad stuff getting triage/stabilization, then the survivors flying to the OHSU teaching hospital in Portland.<br /><br />Oregon Tech is now doing nursing instruction, so there's a pool of semi-trained people. OHSU is in a partnership with Sky Lakes and its clinic for teaching. They're building a good sized clinic--won't be much smaller than the hospital when its done. We'll see how its set up, but my primary care doc is teaching at the pilot program. I have hopes.<br /><br />We don't get the specialists. Eye procedures stop at cataract surgery and basic diagnostics, so if you need retina or cornea work, it's a trip over the Cascades. Medford has some decent facilities and doctors for that stuff.RCPetenoreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-80602961190113276792018-10-29T19:51:46.533-07:002018-10-29T19:51:46.533-07:00Our county has around 4800 people as of last censu...Our county has around 4800 people as of last census. Our county hospital has driven itself into dire financial straits for a few reasons most self inflicted. First was the inept leadership of a CEO who had no medical background or any sort of relevant background for that matter. She wasted huge sums of money on cosmetics and trying to make the hospital into something it isn't, wasn't and never would be. You're not going to have a major surgery there by choice. You're not going to have a baby there by choice. Nobody is impressed with the 25,000 dollar light fixture in the lobby, in fact they're horrified when they find out what it cost them as taxpayers. It's a bandaid station, the clinic your specialist rotates to a few days a month to see his local patients, the place you go to see your family doctor, the place you go for physical therapy so you don't have to drive 2 hours. If you need to have any sort of major surgery or serious medical issues you go to one of the two regional hospitals or the big league hospitals which are usually university hospitals in larger metro areas. Hell, they're not even getting the bandaid station thing right. People were calling the ER before going to see who was working. If a certain physician was on duty people drove an hour to somewhere else. If someone who has tangled with a chainsaw and lost, calls first to see if Dr. Asshole is on duty and upon finding he is, drives 90 minutes to another ER you have a staffing issue. <br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-61675691641423114902018-10-29T19:27:33.595-07:002018-10-29T19:27:33.595-07:00I'd bet new yawk city hasn't thought much ...I'd bet new yawk city hasn't thought much about flyover country and hicks since the urban television execs did the rural purge in the early '70s. RJnoreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-26994377955771733612018-10-29T19:26:40.860-07:002018-10-29T19:26:40.860-07:00Agreed! And yet when 'they' move to the &#...Agreed! And yet when 'they' move to the 'country', they expect ALL of those things they have in the big city! Sigh...Old NFOhttps://www.blogger.com/profile/16404197287935017147noreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-7350512794574872602018-10-29T17:52:12.952-07:002018-10-29T17:52:12.952-07:00Realize we're talking decades ago, but my expe...Realize we're talking decades ago, but my experience with rural hospitals (county seat of 10,000 people) was that it was good for "routine" emergencies and basically stabilized anything serious for transport to the U of Iowa hospital an hour away by road or 20 minutes by helo.<br /><br />I was lucky, born there, in once for minor surgery and once for a few stitches to the foot, and to get an infected ear lanced and cleaned at 0 god thirty once.<br /><br />Little brother, unfortunately, got the benefit of their stabilized and into the helo care after a nasty car accident. Almost 40 years later he's still annoying me ;-)<br /><br />Can't complain about the care in either case. Which, if I read you right, is the model you are laying out. Seemed to work then.RandyGChttps://www.blogger.com/profile/16758726126424011542noreply@blogger.com