Thursday, September 17, 2009

Primary Care Hospitals

Earlier this week I was visiting my home town of Harlan, Iowa (pop. c. 5500) when my almost-83-year-old prostate gland shut down my plumbing. In addition to the resulting discomfort, the incident caused more than a little anxiety since I was scheduled to fly back home to Massachusetts on the following day.

Needing care, I went to the Emergency Room of Myrtue Medical Center, some five minutes by car from where I was staying. Myrtue Medical Center is a 25-bed critical access hospital with a salaried medical staff.

I found a parking place (free) about 30 yards from the ER entrance. After a brief registration exercise, I was taken to an exam room where a nursing assistant hooked me up to a wall-mounted, digital, vital signs monitor. A urine sample (I was able to express enough for that - barely) was sent to the lab to check for infection. A nurse interviewed me. After the lab reported, I was visited by a Physician’s Assistant who interviewed me further (learning, among other things, of a recent cystoscopy that found my bladder normal) palpated my bladder area and ordered an ultrasound scan. Another nurse wheeled in a portable ultrasound machine (about the size of my laptop) and took a picture. The machine estimated that my bladder was holding about 640 ccs of urine.

The lab reported no infection. The nurse then inserted a Foley catheter and collected about 675 ccs of urine (pretty close to the ultrasound machine’s calculation). When that was finished, she fitted me out with a urine collection bag strapped to my leg for use until I arrived home in Massachusetts for further treatment by my doctor there. She gave me a copy of the medical record, together with a prescription for a prophylactic antibiotic (a precaution against infection at the catheter site) and sent me on my way.

I went across the street to a pharmacy that filled the prescription.

The entire episode lasted less than three hours.

Going over the experience with wife Marilyn afterwards, I realized that if a Harlan man had the same experience while visiting Boston and had gone to the internationally renowned, Harvard affiliated Massachusetts General Hospital, the clinical care would have been no better, the bill much higher, and the elapsed time a whole lot longer.

Those interested in the design of our health care system talk a lot about primary care physicians and medical homes. They ought also to talk about primary care hospitals (like Myrtue Medical Center) which can manage most medical situations just as well as the big places – maybe even better - with a lot less fuss and bother and at much lower cost.

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