EVERYTHING CHANGES

Because both science and demographics are changing so rapidly, health care is  transforming daily.  This patient/person is also changing.  Yesterday I didn't post because I drove to Great Falls to see a doctor I respect. It was a big deal because it was the first time I'd driven that far after dislocating my shoulder.  I still can't dependably turn the steering wheel except with my right arm.  There's little traffic here and I was only in the big town for about six blocks, so I risked it.  It's been more than a month since emergency care.

I got to know this doc because she was the physician at the one-day-a-week Valier clinic.  In twenty years I've seen a long line of professionals there, mostly women. I won't go back until I see who the next turnover brings.  The supporting hospital, which is in Shelby, has also deconstructed and reorganized in the last decade.  I hear they have joined a consortium of Mormon-sponsored hospitals around the NW, but there's little info.  In the process most of the docs scattered to other towns.  

A small group formed in Great Falls and called themselves Family Practice.  My doc was part of that group.  More recently that practice has changed and is now called Alluvion Health.

"Alluvion is federally funded and the target demographic is those at 200 percent of the poverty level or below. Besich said last fall that there are 32,000 people in Cascade County in that category.

"The federal poverty level for 2018, according to healthcare.gov, was $12,140 for an individual and 200 percent of the poverty level is $24,280.

"Alluvion is a non-profit with a governing board.

"CCHD opened what was previously called the Community Health Care Center in 1994 to support increased access to care for the uninsured, underinsured and underserved patients. In 2012, the CHCC started operating as a separate department within the county with a long-term goal of becoming an independent agency, according to CHCC.

"Alluvion offers medical, dental and behavior health services. They’ve also partnered with Gateway to provide addiction services."

I do not think this agency could exist without so many women becoming doctors or without the overwhelming army of women occupying quasi-physician positions.  No longer are doctors typically male, older, white, high prestige, high pay positions.  There are young, male, white, often unidentified or unlabeled in quiet offices, suits who are NOT doctors.  They have degrees in business or finance.

Two things have damaged the profession of doctors in Montana.  One is the very long distances and remoteness which hamper establishing a reputation or building a big practice.  Another is that in the ranking of regulations and ethics-reviews, Montana is at the bottom -- fiftieth out of fifty.  A defense of that is that by keeping secret insurance decisions or malpractice issues, more physicians are willing to work in Montana.  We won't ask why.

I had not understood the nature of Alluvion but am happy that I qualify for their remit.  There's another practice like it in Cut Bank, but I'm following Dr. Marler.  Besides the changes in the medical providers, there seems to be a change in the people served, partly because of more universal health care -- at least until this administration gets their hands on it. Partly because of an almost religious realization that what happens to one, happens to us all.

The questionnaire at intake is always interesting as an indicator or orientation of the agency.  This time they asked whether I'd had sex in the last decade (I'm 80.).   I had three choices for "sex" identity, basically male, female or mind your own business.  (The Valier postmaster's doctor offered six sexes, including transitioning, cis, and fluid.)  They pressed hard about addiction.  I confessed that because of my shoulder I'm taking enough aspirin to make my ears ring but wasn't sure that's what they meant.  They didn't ask whether I had HIV.  (I don't.)  My records from earlier years were misplaced.

Great Falls doesn't have a lot of street people -- it's a tough climate -- but there were questions about access to shelter, food and so on.  No question was about access to bathrooms or sanitation supplies.  None were about a criminal record, but that's easily accessed by internet.  The small city does have a great many shelters, supported care facilities, and SRO hotels.  17% of the population is considered aged.  Several versions of question wanted to know whether I were unhappy, depressed, or isolated.  (If I were not isolated, I would be depressed.)

I suspect that some people served by this practice will be troublesome, not quite socialized, organically or psychologically damaged in a nonconforming way, separated from family, unattached.  The attention given to mental help is indicative.  

A growing different group are people like me. There was no question about education level or vocational experience, I suppose to escape from stigma in this place where everyone thinks a high education guarantees security and income.  If you're poor it's because you're stupid.  Parents have pressed their kids to be professors rather than plumbers.  Too many, even young ones right out of college, cannot find a place in the world, even as employers complain that no one will take their jobs.  As insurance leaves its connection to work, people neglect prevention.  Families are problematic.  There is no expectation that ordinary people can send their children to college. 

I know too much to be blindly obedient.  I will not accept patronizing or bullying, esp. from a quasi-professional woman educated via a correspondence course.  Media-promoted pharma issues are dishonest.  At least meds are standardized for white people like me, but not for women or the aged.  I took college statistics three times before I passed the first half of the course, but even I can see that many medical studies are shoddy.  Research travels fast.  

I have diabetes: there are five proposed KINDS of diabetes at present.  Each addressed a different way.  More than one doctor has bluntly told me that I will gradually increase my meds until I'm taking several that are no longer effective and then on insulin for $1000 a dose.  Then I'll be blind with amputated feet.  And I'll die.  Their chosen method of persuasion was threats.  Behind that power position was the craven feeling that I'm not worth their time, unimportant, too much trouble for a woman like them who is at the top.

Many of the indicators of "losers" and low status people are out of date: clothing, tattoos, vocabulary, blue hair, lack of money, skin color.  Old, slow, unfashionable.  A practice like Alluvion understands that life is a stream.  (Alluvial is an environmental term.)  It changes all the time.
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If you have the guts for it, this is a story about a homeless woman who died under a GF bridge a few days ago.

https://www.greatfallstribune.com/story/news/2019/03/27/barbara-snider-lovable-homeless-woman-lived-died-under-bridge-great-falls/3143542002/