Shortly after I turned 50 I scheduled a colonoscopy. I was aware that colorectal cancer in Maine is both common and deadly.1 The doctor who did the procedure is my husband’s primary care provider, someone I’ve come to know. That connection eased my apprehension. He explained that screening for colorectal cancer helps to improve health outcomes by detecting existing cancer at an early stage, when treatment is most beneficial.
The screening worked as it should, but the news wasn’t great. It detected cancer, a small tumor that would need to be surgically removed. I had choices to make. Should I travel many miles to the large urban tertiary center, where they advertised their connection with the Dana Farber institute? Or should I stay close to home and family, where I have deep and long-term bonds with the providers that would be caring for me? Either option meant I would get the treatment I needed, but would I get the best care if I did what I wanted and stayed local? I was familiar with the body of research about the positive relationship between hospital volume and patient outcomes.2 And, I’d also seen research that made me think that in my situation volume wasn’t really an issue.3 Lots of studies underscore the importance of provider-patient trust within a context of good communication.4
My own primary care physician had absolute confidence in the abilities of the local general surgeon at our critical access hospital to perform the surgery I required. Others in my life were adamant that I should go to Portland or Bangor to receive care from highly trained specialists that do these procedures more often. I met with the general surgeon and asked many questions. How often does he perform this kind of surgery? What have been the outcomes? Was there anything about my case that seemed complicated? I received straightforward, thoughtful responses. It was clear that all surgeries have risks, and there were many unknowns. There could be no guarantees about the outcome no matter where I had the surgery.
Through a big chunk of my career I’ve been a supporter of small rural providers and hospitals. It was not lost on me that this was now the opportunity for me to walk the talk. After giving a lot of thought to my own personal set of circumstances, I decided to go ahead and have the surgery locally. I was reassured by knowing that my care plan would be reviewed by a panel of cancer experts at the health system my hospital belongs to. Also, the local general surgeon had significant experience in gastroenterology and performs similar surgical procedures regularly.
I’m happy to say I’m now cancer-free and I have no regrets. While the experience wasn’t without complications, as few things in life are, the caring individuals I encountered every step of the way bolstered my spirits and confidence in our local hospital. Oftentimes the staff people at the hospital and the home health services were my neighbors, or friends, or friends of friends. The value of the personal connections helped me to heal. It made a very scary health crisis easier to manage.
I’m so thankful that I got the cancer screening and caught it early. Knowing about the financial hardship so many small rural health care providers are facing, I’m thankful to have such a terrific hospital so nearby. As I paid each bill following my treatment, I thought of it as doing my small part to ensure that the hospital will continue to be a part of our community into the future, recognizing that we each have an important role to play, as patient and provider, in helping each other thrive.
And when I think about this on a professional level, I have recommitted to helping Maine figure out how to keep important hospital services local when quality can be assured, and to helping other patients navigate the challenging medical choices they face.
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