About three years ago I blogged about “The Treating Physician,” but it fell to the wayside as my physician husband opened his own clinic in rural North Dakota and it was all hands on deck to survive. In these past two and a half years I have learned more about health care billing and insurance than I ever cared to know. And then some.
Health care in rural America gets a lot of press, at least here in rural America. North Dakota’s Senator Conrad has worked for years to try to bring some sort of equalization to the disparity in Medicare payments between rural and metropolitan areas. There is some delusion at the federal level that it costs rural physicians less money to practice, and therefore they should be reimbursed at significantly lower rates for the same care provided by metropolitan physicians. Even though physicians in North Dakota provide Medicare patients with a level of care rated higher by Medicare than most other states in the Union, the federal government sees nothing wrong with paying them significantly less for the better care provided patients.
And then there’s the chronic problem of how to keep physicians down on the farm. There’s a tired old excuse that physician’s wives won’t live in small towns. While it’s true some won’t, this excuse is highly overrated. There’s a far greater underlying problem. No established small town physician is going to tolerate another physician setting up shop in his or her back yard. Few people will talk about this. There are many ways to solve this problem, but it has to be publicly acknowledged before it can be addressed.
And then there’s the matter of being on call 24/7. Thirty years ago, physicians tolerated this. But the new crop of medical school graduates expect to have a life of their own. Maybe actually get out of Dodge for a day now and then.
My earlier posts are in the Archives here, but times, they are a changing—really fast. At this point in time, these earlier posts may seem a bit quaint, but the books I referenced back then are still in print and readily available on Amazon.
The minds of human beings are wired for story, according to many who study the way we learn. In Tell Me a Story, Robert C. Schank outlines how stories structure our thinking. Blogs, I suspect, are so popular because a blog is the new color of journaling. Researchers are always quick to tell us that stories are anecdotal, and therefore have little relevancy in research. But story is what draws us around the fire to share our human experience, as varied as it may be. Unfortunately, most of the efforts to right what is wrong with health care today tend to denigrate story and aspire to “evidence-based” medicine.
The truth is, we need both to correct the problems in health care today.