The Prairie Doc Perspective

Do you have a medical home?

By Richard P. Holm M.D.

In Robert Frost’s Poem “The Death of the Hired Man,” Mary and Warren sit on the back porch steps talking of their old hired man who this night returned to their farm in his last dying days promising to work again. It is then that Warren speaks to the value of having a place to go:

Home is the place where, when you have to go there,

            They have to take you in.’

The same goes for having a medical home. As a kid, growing up in rural South Dakota, I knew my doctor, and for our family he would give our immunizations, sew-up our lacerations, treat our sore throats, and help relieve our pain. He would even be there to support us when we were struck with impossible tragedy. His was a place where, when you had to go there, he would take you in, and do his best to help. I didn’t realize at the time how extremely valuable access to health care could be.

Years later in an Atlanta hospital, as an intern, I rotated onto the team that had to face vast waiting rooms of patients, some waiting more than twelve hours. I remember one fellow intern who bragged about seeing 45 patients in less than three hours. It is hard to call that “access” when you get less than four minutes with a green intern for a medical problem that was trouble enough to cause you to wait that long.

Still, many people in this country, especially those without insurance, have access to health care only through an extremely expensive emergency room somewhere. There they wait to see a complete stranger who must see them as a liability risk, and thus is encouraged to order every expensive test.  However, in the end, the ER doc’s hardest and most important job is to find somewhere or someone to take the patient in follow-up.

And what’s worse, too often there is no one to take the hand-off, no medical home where the patient can go. Too many are medically homeless. I believe that, in our society, every person should have a medical home, and until then, health care costs will continue to rise, and quality will continue to be inadequate.

So far in rural South Dakota, most of us still do have a medical home, now often a PA/nurse practitioner/doctor team, and we should realize that it is something of extraordinary value.

After all, everyone needs a place that, when we have to go there, they will take us in.

Dr. Rick Holm wrote this Prairie Doc Perspective for “On Call®,” a weekly program where medical professionals discuss health concerns for the general public.  “On Call®” is produced by the Healing Words Foundation in association with the South Dakota State University Journalism Department. “On Call®” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain. Visit us at 


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