A World Without House Calls

by Deborah Huso, Contributing Writer

As a child growing up in rural Virginia 25 years ago, I had the privilege of living in an era of country doctors who grew old along with the communities they served. It is an era that has largely passed, and the fact that I have maintained the same family physician as a resident of one of Virginia�s most isolated counties for the past six years is nothing short of remarkable. And necessary, I think, for my good health and the health of my family.

Nevertheless, I still live in one of 36 Virginia counties that are considered medically underserved, according to the Virginia Department of Health�s Office of Health Policy and Planning. Even more areas, particularly rural ones, suffer from shortages of primary-care providers. But it�s not just the number of health-care providers that is going down in rural areas.

Quality of care is another issue. Rural residents who were once accustomed to doctors who could name all their patients� grandchildren have trouble adjusting to young, fresh-out-of-med-school doctors who perform two-year stints in rural health clinics and then move on, or to long drives to the city where they receive substandard care from providers who see hundreds of patients a day and can�t distinguish one from another.

My family�s doctor has served pancakes with me at the local maple festival, chowed down hot dogs with me at Ruritan Club picnics, and even backed into my car with his Jeep. You may wonder why this matters. I didn�t think it did until I was expecting my first child and was exposed to a cadr� of health-care professionals who not only had never had a friendly fender-bender with me, but didn�t have the slightest clue who I was and really didn�t care.

It started when I sought care from a group of certified professional midwives, thinking I would have more personalized attention from a midwife than an obstetrician. I was wrong. Every time I had a prenatal-care appointment, I got shifted among four different midwives. I was told this was necessary because any one of the four might be on call when I was in labor, and surely I wouldn�t want a complete stranger delivering my baby? As if a woman exhausted by 31 hours of labor would care who is on the receiving end.

What I cared about was who was going to walk me through my first experience of pregnancy and motherhood. As it turned out, no one in particular. Every time I visited, I had to explain to a different midwife why I lived 68 miles away, why my husband was away overseas, why I was self-employed, and why I was fixing fence in 90-degree heat or shoveling gravel on the driveway when I should be �taking it easy.� Somehow I doubt my general practitioner in Highland County, who himself lives on a mountaintop in the middle of nowhere, would have been asking me any of these questions. 

The fact is health-care professionals in more urbanized areas, besides providing cattle-chute care to one more patient in the barnyard, have very little grasp of the unique issues facing rural residents, one of which is transportation. When I was at eight months, my midwives required me to come over the mountains at least once a week for a five-minute appointment. These trips entailed taking nearly an entire day off work, a three- to four-hour roundtrip drive, and usually at least an hour-long wait at the midwives� office. One day it entailed a two-hour wait, and when I got up to complain, the receptionist told me they were running behind and could I come back the next day? I was livid, and I told the office staff I�d call them when I was in labor. Which is pretty much how it happened.

Things were no better once my daughter was born. After more than 30 hours in labor, hospital staff harassed me nearly once an hour for the remaining 48 hours of my stay, including 3 a.m. blood-pressure checks and dinner menu requests (as if it mattered when even the Salisbury steak tasted like Jell-o). When the stress of temporary single parenthood and returning to work four days after my daughter�s birth kept me from sleeping for weeks on end, postnatal-care providers strung me along for three months with lame suggestions that perhaps I was suffering from sleep apnea or needed to drink more chamomile tea. It took my family doctor to set things right with something as simple as a prescription for sleeping pills.

I was a victim of getting lost in the shuffle. And I�d seen it before. Several years ago, my father found himself suffering from chronic chest pain. For five years, he was taking regular trips to the hospital in Charlottesville in the middle of the night, fearful of heart trouble. For five years, heart specialists sent him home with pills for heartburn. Finally, my dad�s general practitioner, a rural doctor whose children had been students in my mother�s English classes and played in the marching band with me when I was a teenager, put his foot down and demanded that Dad receive a catheterization. The result? Dad had a blockage in one of the arteries leading to his heart. To this day, I believe my parents� family doctor saved my father�s life. My dad was lucky to have an advocate.

But as outrageous insurance costs and in�creasing regulations drive small-town doctors out of business, fewer and fewer of us have advocates. A couple of years ago, my uncle, a small-town dentist, was forced into early retirement because he couldn�t afford to meet these rising costs. Hundreds of senior citizens,  who had benefited from his low rates and sometimes acceptance of produce in exchange for a teeth-cleaning, no longer have oral care.

With insurance companies ruling America�s health-care roost, we shouldn�t expect the situation to get any better. And while tele-medicine promises to give a lot of rural residents access to care they might not otherwise have, just how good a diagnosis can a doctor give to a person he has never met? 

If the registered nurse in Harrisonburg who told a lone mother with a one-month-old � 120 miles from her closest family member or friend, with editorial deadlines looming and no time to even eat, much less sleep � to soothe her insomnia with a cup of chamomile tea is any indication, the prospects don�t look good.

Fortunately, my family doctor (who happily gives out his cell phone number to patients and will call at 9 p.m. just to make sure the cereal/infant-formula mixture he recommended is working for my daughter�s stomach troubles while asking quickly after my dad�s chest pain, even though my dad isn�t his patient), has a three-year contract left here in Highland.  What happens after that, or what happens to the rest of rural Virginians who don�t even have a doctor, is anybody�s guess. Presidential candidates can promise access to health insurance for every American till they�re blue in the face. What they can�t promise, however, is access to quality care.