Getting to the Doctor When You’re Sick and Scared

Portland is 322 miles from Van Buren, where I work. Some medical sub-specialty clinics are only available down there, at the opposite end of our state.

I have many patients who don’t trusts their vehicle or their driving savvy to get to Portland, and others who don’t have the gas money to drive there and back for a consultation. Many don’t even have a car.

Amy S. is a young woman with a newly diagnosed gynecological malignancy. The only specialist who deals with her condition is in Portland. Actually, they do their surgeries in Portland, but their office is in Scarborough, a suburb. Amy has neither a car nor a drivers license. She has no family locally and her boyfriend dumped her last winter. She is still trying to figure out what to do next in her life. She feels very alone here at the end of the land.

Her only option for getting to Portland is with a transportation service that is available for Medicaid patients. They don’t have any drivers of their own. Instead, they coordinate public and private resources.

I saw her today, distraught and confused. She had walked to my clinic in the muggy 86 degree weather.

“I don’t know if I can do this”, she said. “I’m supposed to get a taxi to catch the 5:45 am bus from Caribou, and…” she continued to rattle off a very complicated list of times and modes of transportations.

“Wait a minute”, I said. “The Cyr bus from Caribou to Bangor leaves at 7. I know that, because I have dropped people off there many times. And Cyr doesn’t have a bus from Bangor to Portland. Who is the carrier for that one? And, how did you say you’re getting from the Portland bus terminal to the doctor’s office? Do you have this schedule in writing?”

“No, they talked so fast on the phone”, she said, throwing her hands in the air.

Amy has ADHD, PTSD and social anxiety. She is clearly overwhelmed with her situation and her new diagnosis.

“Do you mind if I call them”, I asked.

“No, I wish you would. I’m so confused”, she answered as she turned on her phone to look up the number.

I went back to my office and dialed the 800 number.

I was greeted by an “automated attendant” who asked if [my clinic phone number] was the account I was calling about. I said “no”. I said “Attendant”, but didn’t get one until I had spoken “the ten digit phone number associated with this account”.

A man with a southern accent greeted me and I said I wanted to clarify my patient’s travel. He looked up her account. Then there was a long pause.

“Oh, my”, he said. “This looks complicated. Give me a minute.”

It took a full five minutes, which is a long time in a pressure-cooker primary care environment. But then he started reading the itinerary, after first stating that it is complicated because it is over 100 miles. “Right, three times more, each way”, I said.

I scribbled the schedule down and brought it back to my patient. She seemed to feel a bit better having it on paper and said “I think I can do it”.

Tomorrow I will be watching for a report from Portland. Or a call from Amy that she didn’t make it down there.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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