The first meeting with a group of Amish patients

An excerpt from Pet Goats and Pap Smears.

Phoning isn’t an option. Nor is e-mail. So I write a letter to the head elder, asking that the Amish community meet with me. He agrees.

Today is the day. I accompany Steve, the hospital CEO, to an Upper Midwest town so tiny that the post office is inside the grocery store. On the third floor of a local bank, we open the door to an empty conference room. But when we flip on the lights, we discover twelve bearded Amish men in straw hats. They are wearing matching black work boots, navy blue pants, shirts, and zip-up jackets. The men are seated, evenly spaced from eldest to youngest in a slight semicircle.

My first thought is that maybe I shouldn’t be wearing a short skirt with a low-cut blouse.

I smile, introduce myself, and begin: “We’re here today to serve you, to listen to your dreams, your visions of ideal health care.”

No response.

I lean forward. “How can we help you be comfortable in the hospital?”

Silence.

I wait.

They sit quietly.

I stare at them.

They stare at me.

Then an elder says, “We’re comfortable now.”

After thirty minutes, I’m still trying to get a dialogue going. “Please tell us your views on health, disease, death.”

No reaction.

“Okay then, I’ll tell you about me. I’m a family doc from Oregon. I got tired of pushing patients around, so I held town hall meetings to ask people what they want. You know what people want? They want to go back to the 1950s when you could walk to the doctor’s office in the neighborhood.”

All at once, all the men smile the same little smile. I don’t know exactly why they are smiling. But what I’m doing must be working, so I keep rambling along in my usual, animated style with lots of hand gestures. A moment later they burst into laughter. What did I say that made them laugh?

I’m noticing that these Amish men react in unison. They all smile at the exact same time. When they laugh, they all laugh at the same instant, and now they’re all staring at me with big, beautiful smiles. And they begin to share their lives with me.

“We like to pay our bills,” the head elder states. “We collect door to door in our community. Families contribute what they can, but sometimes the hospital won’t take our money. We don’t want charity care. We want to pay our fair share.”

One man pulls out a piece of paper. “This is the bill for my son’s surgery. He injured his arm. Had a simple surgery. Took an hour. They charged us for two anesthesiologists. Did my son need two anesthesiologists?”

“That’s a good question,” I reply.

The CEO reaches over for the bill and explains, “With the new health care laws, you’ll be covered by insurance.”

“To have health insurance means one doesn’t trust in God,” an elder states. “What we request is a fair bill.”

“Yes, that’s what Americans want: a fair bill,” I add.

I look at the CEO and suggest, “Let’s give fifty percent off at the door for anyone religiously opposed to lawsuits.”

“I’ll work on it,” he says.

Now all the Amish men want to tell their stories.

“If we have a child in the hospital with a burn,” a young man shares, “we find burdock leaves prevent the need for skin grafts.”

All the men nod in unison.

“I eat burdock root,” I reply, “but I’ve never used the leaves.”

We all smile.

Another man says, “We like hospitals that respect our use of medicines that we find helpful.”

“That makes sense. Do hospitals honor your wishes?” I ask.

“Some do.”

“Where do you go?”

“To Ohio,” says the head elder.

“Really? All the way to Ohio?”

“For my wife’s gallbladder surgery, we loaded our family on the train to Ohio,” explains a short, middle-aged man. “The hospital there is seventy percent cheaper.”

“I know physician reimbursement is lower in Ohio,” I acknowledge. “I guess that works to your advantage. But we want to serve you here at home so you won’t need to take the train out of state.”

After two hours, I stand up and approach the twelve men. One by one, I shake their hands. “It was such an honor to meet you all. Thank you for allowing me to be here.”

The first gentleman looks up. “So you’re moving here to be our doctor?”

“No, I’m going home to Oregon.”

“You’re not moving here to be our doctor?” another man begs.

“I wish I could be your doctor.” I pause, hold his hand, and smile. “But I’m helping doctors all over the country to be the kind of doctors people want.”

The first meeting with a group of Amish patients

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears.

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  • ninguem

    I practiced in Holmes County Ohio, long ago.

    Pomerene Hospital in Millersburg might have been where that family was headed. We had Amish patients all the time. They paid cash. Major surgery, farm trauma. They know the prices, they had those meetings with civic leaders long ago. They’re not babes in the woods.

  • Guest

    The aversion to insurance also has to do with wanting as little to do with the English and their (our) world as possible, and because it could be seen as akin to gambling. You are giving money to a stranger, outside your community, in the hopes that your “pay-off” will be more than you put in. And insurance companies make a profit off the fact that there is pain and suffering in the world, and there are people so alienated from their families and communities that there is no-one close to them willing to help them in their time of need – so they must turn to strangers, who then profit off their fear. Have you ever thought of it that way? Members of Amish communities will raise and collect money from within when there’s a large bill to pay, sometimes they even have a more formalized “community fund” built up for such exigencies. But by and large they try to look after their own, and come up with Biblically and culturally appropriate ways to deal with the outside world when they must.

    Their communities are finely-tuned machines, more sophisticated than many outsiders understand, and have been successful for them for centuries now.

    • ninguem

      ^^^ What Guest said ^^^

      The Amish can live without heavy investment in schools, they can build their own easily enough. They don’t need sewer systems, power stations, etc.

      If they’re treated badly by the local community, they can oppose local ballot issues and put the nearby town into the middle ages without a sewage treatment plant upgrade or a school with a leaky roof or a failing power system, while they sit just fine with outhouses and candles and their own schools that may do a better job than your inner-city schools.

      They’re more sophisticated than people think sometimes.

  • ninguem

    The cartoon is missing something. I know.

    “…..Thou art attractive, but thy pet goat is hot……”

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