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Medical Folks: Your Thoughts On Rural Hospitals  
User currently offlineJCS17 From United States of America, joined Jun 2001, 8065 posts, RR: 39
Posted (5 years 8 months 3 weeks 6 days 9 hours ago) and read 2033 times:

In August, my grandfather passed away at age 84 from kidney failure. Unfortunately, he and his wife had moved from South Florida to Johnson City, TN. just a few year earlier to be closer to my aunts family, who tends to live in God-awful rural places. He cited the fact that he didn't want either one of them to be stuck in Florida should one of them pass away. Fair enough. The day before he went into have a very minor lung operation, he shot two over par on the local golf course, so he was quite a healthy and active man for 84. Anyway, to make a long story short, he developed an embolism following the surgery that was done at a local hospital. My aunts (one of whom was a hospital administrator in Shreveport, of all places) complained about the care he was given, and told my father and my uncle that Johnson City's hospital staff were "unattentive and poor." Well, he finally recovered enough so he could go home. Two days later, he was back in the hospital as an infection had developed. Anyhow, a week later he dies of kidney failure in Johnson City, and I got a surprisingly good bereavement fare to the funeral.

I just found out today that my father and my uncle had told my aunts that they would take care of chartering him to a hospital in Knoxville, Nashville, or at least Roanoke for higher quality care. For some reason, my aunts refused to allow him to be transferred. Why? They're bad people who somehow thought my father and uncle were trying to curry favor with my grandmother (as if my grandparents were rich).

I'm mildly upset about this. Of course, I don't have my grandfather's medical history in front of me, but how different of an outcome might this have been had he not been stuck in East Pigsknuckle, TN. Is the standard of care that much different in an ICU in Nashville and Johnson City (or even Roanoke). Are the doctors generally that much better in bigger cities? It really bothers me that a man in perfect health for his age could die after a simple procedure because my cheapskate aunts wouldn't take him 100 miles.


America's chickens are coming home to rooooost!
16 replies: All unread, jump to last
 
User currently offlineArmitageShanks From UK - England, joined Dec 2003, 3622 posts, RR: 15
Reply 1, posted (5 years 8 months 3 weeks 6 days 8 hours ago) and read 1999 times:

I live in Johnson City and we have two level 1 trauma centers and numerous other smaller hospitals and clinics within 20 miles, not to mention a large medical school which has one of the best rural medicine programs in the country.

http://www.msha.com/facility.cfm?id=47

http://com.etsu.edu/

We have great medical care here, just like any other city with a population of 60+ thousand.

What facility was he treated at?

[Edited 2008-12-10 16:14:38]

User currently offlineMOBflyer From United States of America, joined Sep 2007, 1209 posts, RR: 4
Reply 2, posted (5 years 8 months 3 weeks 6 days 8 hours ago) and read 1993 times:

I know people that will drive past the open emergency room of a regional medical center en route to one of the several hospitals in Mobile.

User currently offlineDocLightning From United States of America, joined Nov 2005, 19617 posts, RR: 58
Reply 3, posted (5 years 8 months 3 weeks 5 days 2 hours ago) and read 1891 times:



Quoting JCS17 (Thread starter):

I'm mildly upset about this. Of course, I don't have my grandfather's medical history in front of me, but how different of an outcome might this have been had he not been stuck in East Pigsknuckle, TN.

I mean, to be honest, I don't know what his general health was, but it sounds like he died of too much life.

And no hospital can cure that. Keeping someone alive is not the same as keeping them living, if that makes sense.

At 84 and in kidney failure, it's hard to keep those patients alive. And often, they're best off dead.

Now, if your grandfather was a virile, still spry and active man before all this started, then that's different. But if he was already frail, then the better hospital might have extended his life a bit, but they wouldn't have made him better.


User currently offlineKAUSpilot From United States of America, joined Jan 2002, 1958 posts, RR: 32
Reply 4, posted (5 years 8 months 3 weeks 5 days 1 hour ago) and read 1885 times:

My mother is a physician who for many years worked at a medium sized hospital in a town of 20,000. She'd always tell us "if anything ever happens to me, drive me to san antonio", which is about 65 miles away.

My sister broke her arm many years ago in a small town in east texas and my parents insisted on driving to shreveport, a 75 minute drive, rather than patronizing the local emergency room (which they not-so-affectionately referred to as a "roadside medical stand").

The level of care you recieve at a large medical center in a big city is far and away superior to what you get in rural or small town hospitals, for the most part. A lot of it has to do with the fact that hospitals in large cities probably have the volume it takes to be profitable. This means they have the money for all the specialists, the best equipment, and well stocked pharmacies, whereas small town hospitals rely on government subsidies and operate on small budgets. Also, large medical centers often recieve funding from universities or the armed forces, further enhancing the level of care they can provide.

Are the doctors themselves actually better in big cities? Not necessarily, but suffice to say the highest paying jobs are usually in the large cities, and the qualifications required for those jobs are more extensive than what's needed for small town docs.

[Edited 2008-12-11 22:38:14]

User currently offlineDocLightning From United States of America, joined Nov 2005, 19617 posts, RR: 58
Reply 5, posted (5 years 8 months 3 weeks 4 days 17 hours ago) and read 1830 times:

I've also seen people having heart attacks bypass three or four perfectly good emergency rooms only to show up at ours, now too late to do anything about it with the damage permanent, just because they thought we were the "better" hospital.

Had they gone to their local community ER, they would have gotten clot-busters right from the get-go.


User currently offlineJCS17 From United States of America, joined Jun 2001, 8065 posts, RR: 39
Reply 6, posted (5 years 8 months 3 weeks 4 days 1 hour ago) and read 1745 times:



Quoting DocLightning (Reply 3):
Now, if your grandfather was a virile, still spry and active man before all this started, then that's different. But if he was already frail, then the better hospital might have extended his life a bit, but they wouldn't have made him better.

He was though. As I said in my first post, he shot two over par at a local golf course the day before he had his initial surgery done. For someone at 84 to do that is extremely impressive. I talked to him two weeks prior to his minor surgery and he was his regular self. Intelligent, argumentative (he was a complete socialist, so we had fun discussing politics), and just as quick as someone half his age.



America's chickens are coming home to rooooost!
User currently offlineJBirdAV8r From United States of America, joined Jun 2001, 4489 posts, RR: 21
Reply 7, posted (5 years 8 months 3 weeks 4 days ago) and read 1728 times:

Having been born and raised in Johnson City and chosen to live there and brave a 75 mile commute each way to/from work in a TRULY rural area, and with both of my parents in the medical field, I take exception and a tinge of offense to your comments. East Pigsknuckle my ass--we have 60,000 residents and about 200,000 in the metropolitan area. I'm sorry your grandfather passed away, but there's no need to insult my town. We are not Alabama or Mississippi.  Wink

I am sorry about your grandfather. I'm not a medical professional, but I play one on the forums. It seems so hard to draw a comparison of "how would my grandfather have done ____ versus _______?" in such a specific case, but I would say for such a small town we have an outstanding array of hospitals and well-qualified physicians. Every year at least one of our region's hospitals make the Thomson-Reuters Top 100 Hospitals list, and the Johnson City Medical Center is affiliated with the ETSU Quillen College of Pharmacy, one of the top rural medicine schools in the country. Contrary to what you may think, I don't know anyone in the Tri-Cities (and I know quite a few docs) that went to D.O. school in the Caribbean; my girlfriend's mother's boss at the medical center is a MD/PhD graduate from Yale, and the physician/professor supervising my girlfriend's research at the medical school is also Ivy-educated (forgot the school).

And I am not knocking your aunt's experience, but people tend to look at things in a different, more critical light when it concerns such a close family member. And I'm sorry you hold so much disdain for my town, but we're not all country bumpkins who haven't a clue nor a care for medicine. Complications arise even in the best of circumstances.

He could have been in lots worse places than Johnson City for medical care. We may not be on the bleeding edge of medical technology, but for a town of our size, we have quite an advantage.



I got my head checked--by a jumbo jet
User currently offlineSeb146 From United States of America, joined Nov 1999, 11604 posts, RR: 15
Reply 8, posted (5 years 8 months 3 weeks 3 days 15 hours ago) and read 1678 times:

Having grown up in a medical family in rural Oregon, here is what I have observed: Rural hospitals do the best with what they have. If something is out of their reach (which happens a lot), the patient ends up being transferred to a larger hospital. The only hospital in Harney County (Southeast Oregon) is equiped for the basics like broken limbs, routine pregnancies, and the like. Otherwise, the patient it stablized as best they can and transferred, usually to Bend, but, sometimes, to Boise. Pendleton, Hermiston, and The Dalles usually fly extreme cases to Portland or Seattle. Places like Kennewick/Pasco/Richland and Walla Walla, extreme traumas are flown to Spokane or Seattle.

Also, keep in mind that my experiences with small town hospitals are usually in areas under 30 000 people. Bend and Tri-Cities are about 60 000, but I think a "minor lung operaton" would have been done in Portland, Seattle, Boise, or Spokane. There is quality care in rural areas here, but more invasive procedures are preferred to be done in larger cities.



Life in the wall is a drag.
User currently offlineDocLightning From United States of America, joined Nov 2005, 19617 posts, RR: 58
Reply 9, posted (5 years 8 months 3 weeks 3 days 12 hours ago) and read 1651 times:



Quoting JCS17 (Reply 6):

He was though. As I said in my first post, he shot two over par at a local golf course the day before he had his initial surgery done. For someone at 84 to do that is extremely impressive. I talked to him two weeks prior to his minor surgery and he was his regular self. Intelligent, argumentative (he was a complete socialist, so we had fun discussing politics), and just as quick as someone half his age.

Then I'd need to know the details of the situation to ascertain whether it was poor care or poor luck.

Either way, I hope very much that I die at 84 being able to play a game of golf up until the week before I go.


User currently offlinePhoenix9 From Canada, joined Aug 2007, 2546 posts, RR: 8
Reply 10, posted (5 years 8 months 3 weeks 3 days 11 hours ago) and read 1643 times:



Quoting JCS17 (Thread starter):
he developed an embolism following the surgery that was done at a local hospital.

I am sorry for your loss...it can never be easy to loose a loved one.

As for the embolism, it can develop after surgery even if you are in a better hospital. At 84, your body will not respond to such a stress as surgery as if you were a 20 year old. Developing infection and the following treatment with high potency antibiotics probably stressed his physiological system beyond his body could handle. Additionally, the doctors in rural hospitals are stretched to their limits since majority want to stay and work in a city and not a rural area. So per capita availability of doctors is far too lower in rural areas then the city. I don't know about US, but here in Canada, the govt. has special incentives if you sign a contract to work in a rural area (e.g. med school fees is paid and under certain circumstances you get paid while to study, added bonus for rural appointment etc.) and most medical schools require their students to complete rural rotations before they can get their degree. Still after all this...there is acute shortage of doctors (especially for specialists) all over Canada.

However, as others have mentioned, larger hospitals are better equipped to handle such situations and your grandfather would probably have been amongst you if he was indeed transferred to a better hospital. I hope your family finds solace in the fact that he had a long life with much love from his family.



Life only makes sense when you look at it backwards.
User currently offlineBeta From United States of America, joined Nov 2006, 295 posts, RR: 0
Reply 11, posted (5 years 8 months 3 weeks 3 days 11 hours ago) and read 1640 times:

Words of caution: Bigger does not necessarily mean better in the medical world. A common misconception in the general public says one gets better care in the bigger, tertiary care center. This is most true only in the cases of rare, or complicated medical/surgical problems, where a tertiary care center offers wide array of knowledgeable specialists, right equipment, and more importantly the auxillary staff. For routine medical/surgical care the community hospitals often offer as good, if not better, care. When I was in medical school in early 00s, as part of the discussion on this very topic, I read a research article, in which the authors compared the quality of care between Yale U Medical Center vs a New Haven community hospital (quality of care defined as rate of re-admission, complication, unnecessary procedures, death). Guess who won? Hint: it's not Yale. The reason was most of the works, surgeries, procedures done at the bigger, teaching hospitals were done by residents, who were more stressed given the higher workloads at the bigger hospitals, and naturally more interested in the more complicated, rare, exotic cases to enhance their knowledge base rather than the routine, mundane cases. Whereas a community hospital sees lower volume of patients, less stressful, and is interested in retaining your loyalty, and more apt to treat you as customer. Having said that, are there community hospitals offering piss-poor care? You bet. Drew/King Medical center in LA comes to mind.
My 2 cents.


User currently offlineJCS17 From United States of America, joined Jun 2001, 8065 posts, RR: 39
Reply 12, posted (5 years 8 months 3 weeks 3 days 2 hours ago) and read 1593 times:



Quoting Beta (Reply 11):
Drew/King Medical center in LA comes to mind.

I watch "Trauma: Life in the ER" reruns like an addict (if I had to do it all over again, I'd want to become a trauma surgeon... or a commercial pilot...), but they did an episode at King/Drew and it was chaos like I had never seen on that show.

Quoting JBirdAV8r (Reply 7):
Having been born and raised in Johnson City and chosen to live there and brave a 75 mile commute each way to/from work in a TRULY rural area, and with both of my parents in the medical field, I take exception and a tinge of offense to your comments. East Pigsknuckle my ass--we have 60,000 residents and about 200,000 in the metropolitan area. I'm sorry your grandfather passed away, but there's no need to insult my town.

Don't take it personally, but it's Appalachia -- pure and simple. A lot of old and worn down buildings, little redevelopment, etc. Admittedly, my first time visiting Johnson City was for my grandfathers funeral. Since that time, I decided to stop in Kingsport when I was hauling my stuff while transferring to DC from Dallas. Don't get me wrong, the area is absolutely beautiful geographically. On my drive out of Kingsport, a fresh rain had fallen and fog was covering the peaks of the hills. It was something out of the Pacific Northwest.



America's chickens are coming home to rooooost!
User currently offlineDocLightning From United States of America, joined Nov 2005, 19617 posts, RR: 58
Reply 13, posted (5 years 8 months 3 weeks 3 days 2 hours ago) and read 1592 times:



Quoting JCS17 (Reply 12):

I watch "Trauma: Life in the ER" reruns like an addict (if I had to do it all over again, I'd want to become a trauma surgeon... or a commercial pilot...), but they did an episode at King/Drew and it was chaos like I had never seen on that show.

Do you have ANY idea what the lifestyle of one of those people is like? You're almost 40 before you get a real job. Christmas? You work. New Years? Gotta work. 3AM? gotta work. Kids' soccer game? gotta work. If you told me tomorrow that I either had to stop practicing medicine or I had to be a trauma surgeon, I'd stop practicing in an instant.

Yuck. God bless 'em, because we sure need 'em, but yuck.

The other thing is that a pulmonary embolus is one of those things that you can try to prevent, but even if prevention is done, they can still happen. And they kill people. Essentially instantly. There is nothing you can really do about it.


User currently offlineJCS17 From United States of America, joined Jun 2001, 8065 posts, RR: 39
Reply 14, posted (5 years 8 months 3 weeks 3 days 1 hour ago) and read 1584 times:

Well, I've actually given it a bit of thought... which is odd since I barely passed Biology I in college and dated a girl whose father was a very wealthy plastic surgeon in Atlanta..I think that the thrill and stress of trauma is something that could never be beat even flying planes. To fly an aircraft for 30 years you might have a heart-stopping emergency two times in your career. To do trauma, you have people's lives in your hands 10+ times a night. I'm definitely not a thrill-seeker, but the chance to have an immediate impact on someones life is quite... well... awesome.

You know what my real problem is? I'm seeing you and Superfly in a sympathetic, conciliatory light. Yuck.  Wink



America's chickens are coming home to rooooost!
User currently offlineFlighty From United States of America, joined Apr 2007, 8498 posts, RR: 2
Reply 15, posted (5 years 8 months 3 weeks 3 days 1 hour ago) and read 1583 times:

I agree with DocLighning, things do happen in the hospital, nothing is risk free. Some operations do end in death. We should all hope we live to a ripe old age. I never had any relatives who had good quality of life past 85. Who knows, maybe his medical care could have been better. Or maybe not. But 84 is a pretty solid age, perhaps 90 is better for the truly gifted and physically healthy. But 84 is good.

Old people are a difficult business. I have lot of family in medicine and one thing they say is, your body just isn't much good past age 80 (especially 85 -- with 90 being a hard limit). Any medical care you get past that age is pretty much fighting a losing battle. Surgery isn't the problem, being old is the problem. For everyone's death, there is a cause (whether or not they know it exactly). Lots of people die in hospitals, which of course inspires criticism. This is nothing new. But the fact is, taking care of age 80+ people isn't easy, and fate is what it is. The 85-year old body is the enemy of medical science. Age wins over medicine every day, for the people whose number comes up.

This may sound like rationalizing and moralizing but wait... that's not my point. Hospitals should be run correctly and things should be done right. But when you're 85, a good hospital is pretty much the same as a bad one. In both cases, you're in trouble, statistically speaking. In both cases, your body is going to have problems nobody can solve. The question is which hospital lets you linger on a couple of extra years, in an awful medical existence where you know -- without a doubt -- that your best days are over. Having 2 or 3 days to say goodbye is great; but having 900 days to say goodbye is something best avoided.

It sounds like staff were looking after your grandfather, and tried to help him, so that is good. It sounds like they were well aware of his medical problems and had time to confront them. My condolences to you, never forget your relative.

[Edited 2008-12-13 23:05:36]

User currently offlineDocLightning From United States of America, joined Nov 2005, 19617 posts, RR: 58
Reply 16, posted (5 years 8 months 3 weeks 3 days 1 hour ago) and read 1579 times:



Quoting JCS17 (Reply 14):

You know what my real problem is? I'm seeing you and Superfly in a sympathetic, conciliatory light. Yuck. Wink

HAHAHAHAHA!!!! Sucker!!  Wink


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