Being a Patient in the Kentucky Coalfields

I've been laying in bed for hours every night before falling asleep.  Not completely unusual except for what is keeping me awake is not my racing mind.  It's so loud my mind cannot do any thinking beyond what could be making this overwhelming noise.  Swoosh, swoosh, swoosh, gurgle, pop, swoosh, swoosh, to the beat of my heart.  It's the sound in my right ear.  It is there all the time since September.  Sometimes it is so loud I have a hard time hearing people when they talk.  Other times it is subtle and barely noticeable.  The best times are when there is background noise.  At night, the sound is all that there is.

I Googled it.  It's potentially a lot of things, some of them major things.  Coupled with my terrible migraines it makes me a little wary of it not being looked into quickly.  I went to my family doctor as an ER follow-up for migraine and stomach cramps a few weeks ago and mentioned it to him.  He looked in there and listened to my carotid.  Nothing is clogging my ear.  My carotid sounded fine with the stethoscope.  He recommended I try to get my neurology appointment moved up.  It is scheduled for January.  The appointment was made in October.  I call.  I tell the receptionist why I'd like to get in sooner.  She explains that I'll have to go through the ER at the hospital and the ER doctor will do a consult with the neurologist.  That will be the only way I could be seen by him any sooner.  Thanks and no thanks.  To think we wonder why the cost of healthcare is so outrageous.  Don't blame it on the docs.

So, I wait.  I wait and I analyze.  I wonder.  I wait.  I wait like I've been waiting to see a dermatologist for this thing that has come up that needs examined.  Again, the referral was made in October and I don't see her until December.  After finding out that no dermatologist in my region of the state will accept my insurance, I had to make an appointment with a doctor in Lexington which is three hours away from home.

This isn't unusual for those of us who live in the Kentucky coalfields.  I feel incredibly sorry for people who have limited transportation, funds, and are dealing with a major illness.  A good doctor comes into the region and it is like rolling dice as to when you might actually get an appointment.  Otherwise, you are referred to the surrounding cities for care - two or more hours from home.  Fred D. Baldwin writes in an article titled, "Access to Care: Overcoming the Rural Physician Shortage": "Rural residents must often travel hours to consult specialists, and many rural communities lack even primary care physicians (physicians certified in family practice, internal medicine, pediatrics, obstetrics/gynecology, and psychiatry). In fact, rural Appalachia still labors under a double burden, according to Lyle Snider, research director in the University of Kentucky Center for Rural Health's Division of Community Programs, Research, and Health Policy: the fewest primary care doctors and the most severe health problems. These situations are related: having too few doctors means that dangerous conditions go undiagnosed too long."


The problem of physician shortage has gotten better as I have gotten older.  I can directly see some of the strategies the state and healthcare agencies have used to recruit more doctors into the area.  The most obvious one being recruiting residents of these rural counties into the field.  I can think of my small graduating class and the class under me and point out at least seven of them who became a doctor, midwife, or PA-C and came home again to serve.

I, too often for the small number of times I have actually used an ER, have had the experience of there being cultural and linguistic barriers to receiving proper care.  It seems doctors from outside of the country and/or state were at one time given incentives to practice here.  That's a good thing because without them we'd have been up the creek without a paddle.  However, I very much doubt that they went through any cultural sensitivity training and I know personally from experience that there is often a language barrier as well.  It hasn't been unusual to hear of disappointment in a doctor's visit or a feeling like the doctor didn't take the time to listen and understand.  I know people who have left that little room having no clue what the doctor ordered.

So, that said, it is wonderful to have the opportunity to see a neurologist without leaving eastern Kentucky, even if I have to wait until January.  It is a step forward.  However, the problem is far from being solved.  A report, Rural Kentucky's Physician Shortage: Strategies for producing, recruiting, and retaining primary care providers within a medically underserved region says, "Then there is the issue of retention. One source of dissatisfaction on the part of rural physicians could be that the workload and demands placed upon them generally are greater than those experienced by their metropolitan counterparts.  Those within Kentucky’s health care industry also point to decreased opportunity for professional contacts in medically underserved areas as a reason for premature physician departures from rural regions.  There also are economic concerns. The federal government has become the largest contributor to graduate medical education, paying more than $7 billion annually toward that effort. Yet, federal and state governments have been criticized for failing to develop incentives that better encourage rural practice. Rural physicians typically derive a larger share of their gross practice revenue from Medicaid and Medicare patients, but these publicly supported insurance programs pay physicians at lower rates than private insurers. Rural physicians also typically have received lower Medicaid and Medicare reimbursements than their urban counterparts for performing the same medical procedures."


Well, what do we do?  I couldn't imagine serving in the healthcare field here.  Being a patient within it can be stressful enough.  And, is just another way that living rurally is vastly different from metropolitan living.  So, I wait, albeit not very patiently, to figure out what this potentially big deal thing is going on in my head.  I pretend like it is no thing at all until I lie down at night and it begs for my attention.