Access: It’s not the only thing…
Posted on February 19, 2012
We’re changing doctors; well, Mom and Dad are. When we all first moved here on the ravine, we chose a primary care physician for them from a list provided by Dr. Scoville, Mom and Dad’s cardiologist. We couldn’t get in with the first on the list and the second was out of the country for a couple of months, so we went with the third. Dr. Scoville told us, “They are all fine doctors–but access is going to be very important for you. Choose one that’s available and has good coverage and one that you can be comfortable with.”
We loved this young physician, all of us. We described him to others and to ourselves as “sweet as he can be, and very laid-back.” Whenever we needed to see him, we could always get an appointment within a couple of days, usually the same day as the call. So why are we changing doctors when we got such good access?
Dr. Jones (Heavens, no, that’s not his real name!) has missed too much. Missed the mark. Been dead wrong–perhaps deadly wrong–on too many issues. There were also signs of frustrating inefficiency in billing and coding and office management.
We missed Dr. Jones’s first miss–I’ll explain. Both Mom and Dad had a complete physical in June. I remembered the conversation about his “swallowing problem” and his “stomach trouble” much too late (of course).
We brought a list of current medications, including vitamins and over-the-counter varieties. Dr. Jones asked, “Does the over-the-counter Prisolec take care of the problem?”
“No, not really. I guess it helps,” Dad answered. “But see, I have this problem and they’ve worked on it before. I have a blockage” (he patted his chest) “and they had to go in and stretch it.”
“Hiatal hernia,” I said. Dr. Jones nodded.
“He throws up a lot,” I said. He nodded again.
“Well, he said that’s the way it’s going to be,” Dad said, referring to his old doctor.
We went on to another subject and the physical was over. We left with instructions to continue the current course of medications, call if we needed him, and return for an annual check-up.
In January after that first physical, Dad took an ambulance trip to the hospital with untreated reflux that led to what we used to call “bleeding ulcers.” He was passed out on the floor and incoherent when those muscly EMT’s carried him down the apartment’s steep back stairs. After the hospital stay, he went to the rehabilitation facility for three weeks where they got him walking again.
Then Dr. Jones missed Mom’s gallbladder attack. A covering physician on a weekend called it (over the phone) and sent her to the emergency room. She had surgery the following day. Two misses by Dr. Jones. A few days later, I brought up perhaps looking for another doctor…
Number three was this past week’s diverticulitis. After two visits with Dr. Jones and prescriptions for reflux (yes…), I took Mom to the emergency room on Thursday where she got a CT scan, a quick diagnosis, and some prescriptive antibiotics.
I did not begin the conversation this time about finding a new doctor. Mom did. We have a new, long list of internists and family practice caregivers to choose from. We’ll find a good one, already have one in mind.
The thought occurred that, yes, access is important, but it’s not the only thing.
“Access” has come up in conversation around The Compound several times lately; I suppose you could say “access as it relates to politics“. Politics is defined by my online dictionary as “of or related to the citizenry, the state, the government, public affairs, public administration, policy-making…” Mom and Dad and Dave and I talk a lot of that sort of politics.
Last week, we agreed that access is almost the only thing for a very large group of people around the country–well, even right here in our own city. Vanderbilt and St. Thomas have done a good job of locating clinics in communities with low access to transportation across town. But we all know that the uninsured in line for treatment in those local clinics–as well as the emergency room–are but a fraction of those without the ability to pay for healthcare. Mostly, the uninsured go without care. Most wouldn’t go to the doctor with a bellyache, even a bad one. I think of my friend who chooses to pass kidney stones alone, at home, because she just can’t face owing thousands of dollars for a trip to the ER.
Most of the uninsured go without maintenance medications, those pills and elixirs to control high blood pressure, hyperthyroidism, cholesterol–and reflux. Those who are fortunate enough to get treatment at a clinic or emergency room may not fill the resulting prescriptions. They may have access to a pharmacy but lack the means to pay.
Just a couple of days ago, we talked about another kind of access, access to food. Groceries.
There are areas of town that are named “food deserts.” Those who have taken up the mission of feeding the hungry know about these areas where the only place to shop, if there is one, is a small corner “stop and go”. Sometimes the prices in such places are double what one would see in a larger grocery store. Sometimes that’s the result of price-gouging, but many times the higher prices are what allow that merchant to be there. Many times, that corner market is the only place accessible on foot.
For our neighbors who live in food deserts, access is critical…but it’s not the only thing. One has to have means.
Now, here on the ravine, if we don’t like the looks of the grapes at Kroger, we go to Publix. Or Wal-Mart. Or Maxwell’s. Or Harris Teeter. Mom can’t find canned purple plums except for at one location, so we just add that store as an occasional stop. In the summertime, we make trips downtown to the Farmer’s Market for squash, tomatoes–several varieties, melons, peaches, greens…I can’t remember it all. One of the wholesale clubs is our PRN stop. (PRN…a medical notation for “as needed.”) We order teas and spices online.
Do we have access, or what? And means. We have means.
The Kroger at Elysian Fields closed last week. I wonder if that creates a new food desert in Nashville. That closing has to eliminate access for some somebodies, and if that Kroger’s shoppers find a new store, it just may take more means to get there, more means to pay there.
Change doctors? We can do that. Choose between food stores? We can do that. Drive pretty much where we want? Yes.
We have access. But it’s not the only thing.