State of Maine Column stirs up a hornet’s nest of health-care horror stories

By Jill Goldthwait

After a recent column that compared primary health care providers to “imaginary friends,” a phone call came that was too good not to share. An old acquaintance reported that her granddaughter had two imaginary friends, named Lucy and Plucy.

One day the woman was out in the yard pushing her granddaughter on the swing. “What ever happened to Lucy and Plucy?” she asked. “We haven’t seen them around for a while.” “Oh,” replied the granddaughter with nonchalance, “they moved to ‘Assachusetts.’” There was plenty of other feedback about that particular column, most of which was a lot less charming. It was a series of horror stories from people who tried to access primary care but in most cases without success. Patients had been told when to seek care and where, but when they made the call for an appointment, they found there was no one available to see them, at least in the near term.

One physician describes primary care as a process of writing prescriptions and making referrals rather than offering care, because the physician/patient ratio averages 2,500-3,000 patients per physician, and the duration of an office visit is expected to be about seven minutes. For the patient, who is often shuttled to someone other than their own primary care provider, it means retelling their health care history at every visit.

The American health care system has plenty of woes beyond this question of access to primary care. An opaque billing system and a bewildering array of specialists are among them. Patients are increasingly frustrated and often opt not to seek care at all. Providers are burned out, either choosing to leave the profession or drawing lines in the sand regarding their practices.

Many hospitals searching for physician staff are finding that it is a seller’s market in which doctors who used to tolerate the terms of engagement as “that’s just the way it is” are opting out of what used to be basic job requirements. They want to limit hours worked and do not want to take calls. It is not because they are not committed physicians; it is because the job has become so unpalatable that they can’t bear for it to absorb their whole lives like the old GPs did.

Raise the subject and everyone within earshot has a story. A 14-month wait to get a dermatology appointment as a new patient. Three months before a woman diagnosed with cancer could get her initial “intake” visit at a cancer center. A man who has given up and gets no treatment for his diabetes- related foot infection because it is just so frustrating to slog through what it takes to get a doctor’s appointment. A man with a broken hip who is told he needs physical therapy but there is no one to do it.

Is this just a rural phenomenon? Is it better in larger population areas — cities — because there are more providers there? People report giving up on seeking local care and going to Boston, where they seem able to schedule an appointment and begin care. Lucky them. The cost of traveling to Boston for care puts that option out of reach for many.

This raises a broader question. Is it getting harder to be here? In Maine? It’s not just health care. Need your furnace cleaned, or a broken step fixed? Need a plumber? It’s not on. To their credit, a plumber will usually show up for a real meltdown, but for maintenance-level needs it is virtually impossible to find someone unless your plumber happens to be your son, and even then it’s not a sure thing.

There are some fundamental life needs that, once upon a time, we were able to take care of ourselves. As we became less self-sufficient, there were still the local go-to guys who could take care of our plumbing, heating and carpentry needs. Without enterprising locals willing to do that work for local people, our very ability to stay in Maine, at least north of Cumberland County, is jeopardized.

The dearth of support services is a challenge for yearround Mainers, but the inability to get basic health care when needed is more than an inconvenience. It is a factor that determines whether a born-and-raised Maine family can remain here, or a potential in-migrating family attracted by Maine’s quality of life decides to move here or not.

The tension is between “Maine: The Way Life [Used to] Be” and a Maine that attracts or supports year-round residents. When the systems that support daily life break down, rural communities all over the state face an uphill battle in retaining their population. None of these is more important than knowing basic health care can be obtained when needed. This is no longer a certainty in much of Maine.

Jill Goldthwait worked for 25 years as a registered nurse at Mount Desert Island Hospital. She has served as a Bar Harbor town councilor and as an independent state senator from Hancock County.