It’s been a while since I’ve talked about work on this blog. I tend to not discuss work topics for a number of reasons – primarily because HIPAA makes it harder and harder to discuss situations involving patients – but also when I re-animated this blog, I tried to make it less about me and more about the health care system and health policy in addition to LGBT issues with a smattering of politics and funny current events. I guess this post has some of those “health care system” elements to it.
It’s been over a year since I’ve moved to Louisiana to start my fellowship. I knew that there would be a lot of differences between health care in Massachusetts and Louisiana. I also knew that the uninsured rate and the poverty rate in Louisiana would present challenges in health care. It didn’t take long for this to become painfully clear – especially prior to Medicaid expansion. But a situation occurred yesterday that made me realize not only how challenging the practice of medicine can be for physicians but just how many hurdles we make our patients jump over.
Yesterday was my first day rotating at the Children’s Hospital of New Orleans, and the first Monday of each month is the Craniofacial clinic. It’s a multidisciplinary clinic designed primarily for cleft lip and palate patients but also sees a broad range of craniofacial defects and syndromes. We had a new patient in clinic yesterday. I won’t mention his condition, as it’s not important to the story, but safe to say that he will require a lot of help from the many disciplines from the Craniofacial team – from dentistry, to orthodontics, oral surgery, and plastic surgery. I noted the town in which the patient lived but didn’t really give it much thought, until I later looked up where he lives with his mother.
Four hours. That’s how long it took for his mother to drive to New Orleans to get him to our clinic.
Growing up in Pittsburgh, our local hospital was within walking distance of our house. The University of Pittsburgh and Children’s Hospital were located within a 30 minute drive. In residency, we occasionally had patients from parts of Vermont and New Hampshire come to Boston for treatment, but the majority of our patients were from an hour or less away. Obtaining health care in the places I grew up and where I received my training was rather easy.
To put it into better perspective, Boston and New York City are about a four hour drive apart. Driving from Boston to the end of Cape Cod takes about 2.5 hours. Even Boston to the Canadian border in Vermont is less than a 4 hour drive. You could be in another country in less time than it took for this mom to drive her son to the clinic. Most people day trip to locations closer than where this patient lives.
A four hour drive (8 hours roundtrip) probably requires a tank of gas. It requires meal planning for breakfast, lunch, and perhaps even dinner. And it’s not just the time spent driving. It also means time spent waiting – for the physicians, nurses, social workers, and everyone else involved in the team, and then time spent obtaining any additional studies necessary. And, of course, there is the opportunity cost of that time – a day missed from school and from work. It’s a day of learning and a day’s worth of pay lost.
We sometimes forget and take for granted that the appointments, schedules, orders, and therapies that we require of our patients require an immense amount of cost on their part.