Where is the health care on the Mendocino Coast?
“What do you do for health care around here?” I asked a Mendocino library patron when we were thinking about moving here 15 years ago.
“Oh, we take care of each other.” (I was undergoing breast cancer treatment at the time but didn’t ask whether she had a radiation oncology connection in town.) Even with that naive yet cautionary introduction, I was slow to see how minimal and backward the health-care situation was here. I’ve repeatedly revised my estimate of “where” Mendocino healthcare is; my current estimate is 1995.
My first provider never bothered to look at my chart before seeing me, always greeted me and other patients with, “Have I seen you before?” and, at each visit, admitted to not having checked the medical records I’d brought from Kaiser (because there were too many pages). We were in the middle of a major downsizing, so it took months to notice the topic of preventive care hadn’t come up. Not even a mammogram. (This provider has since been hired on full-time at Adventist.) Prioritizing preventive care was the primary reason we left that doctor.
Our new provider was with what is now the Adventist clinic, and she was excellent; rightly, the first thing she did was address my preventive care, and she learned our names. She’d checked my records before entering the room, saw I was overdue for everything, and set it all up — a mammogram, blood work, a fecal test — in less than five minutes. She subsequently did the same for my husband. Our confidence in basic health care here rose as she looked after us. (She recently moved out of state.)
The next challenge was learning to carry records with me on paper. From the clinic to the lab, from the lab to the clinic, and to any specialist. This continued at the new clinic and after Adventist took over, but the word was we’d be moving to Cerner, their established records management system.
Now, eight months after the “switch,” we still can’t access our records. Even clinicians have to leave exam rooms to check them. Very recent test results aren’t available online.
Switchover completion dates have come and gone without comment or updates from Adventist’s management. At this point, no one seems willing to chance announcing another date.
Last year was an extremely busy and sad one for us, so without any notice to the contrary, I wasn’t aware we were no longer receiving preventive care reminders.
When the realization hit that my husband was well overdue for all of his tests, I was very upset. He’s at risk for lung cancer (due to his former trade and smoking history); diabetes (his entire immediate family); and various cancers, including colon cancer (due to his smoking history), and an abdominal aortal aneurysm (due to his age).
After weeks of frustration, I was able to schedule a tele-visit with our new provider, who seemed great, and she ordered all he needed.
Timely preventive care can help people avoid illness and even death, as opposed to waiting for illness to make itself known. Lung cancer, caught early, is curable. Caught late, it’s terminal. Neglecting preventive care pushes the patient load into the future, and illness that has progressed requires more extensive care. Adventist is exposing themselves to potential liability, first by failing to keep up the practice of reminding patients when care is due and then failing to notify us that we are no longer being reminded.
Most people don’t realize what’s going on. Patients seen at the clinic are routinely checked for their preventive care needs; patients who have not been seen recently may — or may not — have been. Even some staff at the clinic are unaware that this is the case.
Adventist has a moral obligation to notify us that preventive care notices are not being generated, so we can check our own records or insurance sites to see whether they’re overdue. Several weeks ago, I raised the alarm about the lack of consistent preventive care screening notifications with Adventist administrators and requested they notify all their patients of the problem. Nothing.
Not telling people that they aren’t getting preventive care reminders is equivalent to removing a safety net from under an acrobat without telling her. It steals our agency as patients to make informed decisions about our healthcare and withholds critical information from us to maintain a false image.
I want to know:
• Who at Adventist first realized this, and when?
• Did administrators know to take care of their own preventive care needs without telling us to do the same?
• Can Adventist reopen the old patient portal so we can access our records?
• What percentage of the work of porting the data to Cerner is complete? When will the old records be transferred and accessible?
• When will consistent preventive care reminders resume?
• What is Adventist doing to prevent a similar disaster when converting the hospital’s records to Cerner?
Adventist’s communications seem mostly concerned with its image, not with the concerns and health of the patients under its care. To earn our trust, Adventist needs to put their patients’ needs first and be forthcoming about their failings. Otherwise, we can’t take care of ourselves and each other.