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Old 01-13-2013, 11:52 AM
 
Location: Somewhere in northern Alabama
18,549 posts, read 55,485,543 times
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I have got to say that no, medical care in small towns and rural areas is NOT anywhere near as good as certain metropolitan areas. My father had ongoing medical issues, and eventually realized that because they were not the garden variety of problems he needed to seek out better care. Doctors themselves recognize that a surgeon who specializes in a particular surgery will have a much higher success rate than one who only performs the operation a few times a year.

In many cases, day to day medical care is through nurse practitioners with some supervision. I am not saying that there aren't some talented people in rural areas, or that care is unsafe, but the odds are against a rural resident being lucky enough to latch on to an uber-competent doctor. Those folks will gravitate to the Cleveland Clinic, Mayo Clinic, and other top-flight medical providers.
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Old 01-13-2013, 01:47 PM
 
5,090 posts, read 13,706,340 times
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This is an excellent question to start this thread. All the posts have answered about the level of care and the need to go to larger facilities for specialist care.

What has not been mentioned is the issue about emergency care where there is are extreme catastrophic traumatic injuries or illness. In those cases, time is the main issue in getting one to care and the distance you are away from a hospital is crucial and not to any hospital but a Level I Trauma Center.

These Level I Trauma Centers are continually staffed by specialist for this type of care and have the specialist equipment to provide this care. Many areas and cities do not even have any Level I Trauma Center but may have a Level II, or Level III or Level IV. You will not have many Trauma Centers in rural areas and some have none. These lower level trauma centers work with Level I but again distance and time is important to save a life. Some big cities have more than one Level I. So, living near or in a big city is always an advantage in these type of injuries.

You can talk about helicopter transit but there is still the distance and time vs. just taking an ambulance to your city Level 1 Trauma Center. Also, helicopters cannot always fly in bad weather to these remote frontier areas. Keep in mind that the helicopter are maintained at the main trauma center hospital, not at the site of injury or a small town. So, the helicopter has to fly there first and then back to the hospital and that time and distance may be the the deciding factor in saving your life.

That is the state of the matter and more crucial in being a senior. Any traumatic injury or illness must be treated and cared quicker with special care; older people have less of capacity to live through these situations.

Livecontent

Last edited by livecontent; 01-13-2013 at 01:58 PM..
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Old 01-13-2013, 02:06 PM
PDD
 
Location: The Sand Hills of NC
8,774 posts, read 15,164,775 times
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Quote:
Originally Posted by harry chickpea View Post
I have got to say that no, medical care in small towns and rural areas is NOT anywhere near as good as certain metropolitan areas. My father had ongoing medical issues, and eventually realized that because they were not the garden variety of problems he needed to seek out better care. Doctors themselves recognize that a surgeon who specializes in a particular surgery will have a much higher success rate than one who only performs the operation a few times a year.

In many cases, day to day medical care is through nurse practitioners with some supervision. I am not saying that there aren't some talented people in rural areas, or that care is unsafe, but the odds are against a rural resident being lucky enough to latch on to an uber-competent doctor. Those folks will gravitate to the Cleveland Clinic, Mayo Clinic, and other top-flight medical providers.
Most large hospitals that serve rural areas have plenty of competent doctors that can take care of and treat 90% of all their patients. If you need special care they will send you to a specialist in one of the big name hospitals.
To suggest that hospitals are are manned by nurse practitioners is ridiculous.

It is not necessary for everybody to live near the Mayo clinic or NYC medical center in order to be treated properly.
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Old 01-13-2013, 04:02 PM
 
Location: Somewhere in northern Alabama
18,549 posts, read 55,485,543 times
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Quote:
Originally Posted by PDD View Post
Most large hospitals that serve rural areas have plenty of competent doctors that can take care of and treat 90% of all their patients. If you need special care they will send you to a specialist in one of the big name hospitals.
To suggest that hospitals are are manned by nurse practitioners is ridiculous.

It is not necessary for everybody to live near the Mayo clinic or NYC medical center in order to be treated properly.
I did not suggest that "hospitals are are manned by nurse practitioners." In day to day care and even some Doc-in-a-boxes around here, the only person on duty is a nurse practitioner. The supervising doctor is rarely even present.

Yes, special care needs can sometimes be referred - IF the doctor admits to not being comfortable AND the insurance company is willing to go along AND the problem is not so immediate that transport is an issue.

I'll also state that many doctors in the large metropolitan areas are nowhere near the level of competency of those in the big name clinics and teaching hospitals. Chances of being treated properly for common ailments may be nearly equal in rural or metropolitan settings. However... what are the chances that Warren Buffet, Donald Trump, and other high profile citizens chose their doctors based on the convenience of location? The old saw that you get what you pay for still holds sway.
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Old 01-13-2013, 04:07 PM
 
Location: Western Nebraskansas
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Specialized care is ALWAYS referred. Small town hospitals just have GPs, not specialists. That's why there are specialty clinics, afterall...
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Old 01-13-2013, 05:09 PM
PDD
 
Location: The Sand Hills of NC
8,774 posts, read 15,164,775 times
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Quote:
Originally Posted by harry chickpea View Post
I did not suggest that "hospitals are are manned by nurse practitioners." In day to day care and even some Doc-in-a-boxes around here, the only person on duty is a nurse practitioner. The supervising doctor is rarely even present.

Yes, special care needs can sometimes be referred - IF the doctor admits to not being comfortable AND the insurance company is willing to go along AND the problem is not so immediate that transport is an issue.

I'll also state that many doctors in the large metropolitan areas are nowhere near the level of competency of those in the big name clinics and teaching hospitals. Chances of being treated properly for common ailments may be nearly equal in rural or metropolitan settings. However... what are the chances that Warren Buffet, Donald Trump, and other high profile citizens chose their doctors based on the convenience of location? The old saw that you get what you pay for still holds sway.
Let's be honest unless you have specific condition then most people are happy with having a large hospital within 15-20 miles of their home.
I would never choose to live in Podunk with the nearest hospital over 100 miles away but having a large medical center only 10 miles from me is close enough and I am comfortable with that. If I need a specialist I can go to Duke Medical which is 100 miles away.

I really don't care where Buffett or Trump lives in relation to major hospitals. I wonder when they travel by plane do they carry a surgeon/ medical specialist with them?

Are you suggesting that every high profile person in the country lives within a half hour of every major teaching hospital?
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Old 01-14-2013, 09:54 AM
 
Location: Somewhere in northern Alabama
18,549 posts, read 55,485,543 times
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Quote:
Originally Posted by PDD View Post
Let's be honest unless you have specific condition then most people are happy with having a large hospital within 15-20 miles of their home.
I would never choose to live in Podunk with the nearest hospital over 100 miles away but having a large medical center only 10 miles from me is close enough and I am comfortable with that. If I need a specialist I can go to Duke Medical which is 100 miles away.

I really don't care where Buffett or Trump lives in relation to major hospitals. I wonder when they travel by plane do they carry a surgeon/ medical specialist with them?

Are you suggesting that every high profile person in the country lives within a half hour of every major teaching hospital?

The original question was about the competency and availability of rural medical care. There are many areas of the country where there is no hospital within 20 miles, and it IS a concern, especially as people get older. We are about 20 miles from a small hospital, 40 from a mid-size, and 100 from a large hospital. To be able to use the large hospital would require a sign-off from the insurance company, which places a real limitation on the level of medical care easily available. That is a reality that you seem to be unable to accept in the debate.

I don't care where Trump lives either. My point was that those who can afford the best care go where they can find it, something that is not available to most of us rural folks. Your parting rhetorical question was cute, but doesn't further the debate.
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Old 01-14-2013, 10:30 AM
 
374 posts, read 444,429 times
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According to how far away the hospital is.Sometimes the big hospitals are not as good as the smaller ones,imo.
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Old 01-14-2013, 12:43 PM
 
26,710 posts, read 53,365,297 times
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Originally Posted by pokesalad4u2 View Post
According to how far away the hospital is.Sometimes the big hospitals are not as good as the smaller ones,imo.
I work at a hospital...

One of the Doctors was skiing somewhere... Vail or Aspen?

Anyway, he was badly injured and was taken to the small nearby facility.

It was small... but, just happened to have a top orthopedic surgeon on staff... probably because of all the ski accidents.

Just saying you really need to check out what is available and also realize medical care is in a constant state of flux.
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Old 01-14-2013, 05:11 PM
PDD
 
Location: The Sand Hills of NC
8,774 posts, read 15,164,775 times
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Quote:
Originally Posted by harry chickpea View Post
The original question was about the competency and availability of rural medical care. There are many areas of the country where there is no hospital within 20 miles, and it IS a concern, especially as people get older. We are about 20 miles from a small hospital, 40 from a mid-size, and 100 from a large hospital. To be able to use the large hospital would require a sign-off from the insurance company, which places a real limitation on the level of medical care easily available. That is a reality that you seem to be unable to accept in the debate.

I don't care where Trump lives either. My point was that those who can afford the best care go where they can find it, something that is not available to most of us rural folks. Your parting rhetorical question was cute, but doesn't further the debate.
For those people like yourself I agree you are not going to be able to get immediate care by a highly experienced surgeon living 100 miles from the large teaching hospitals.
If your insurance won't cover you perhaps you should consider buying a better health insurance plan.
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