When completed, the 20,000-square-foot building will house one of the most modern emergency departments in the state filled with some of the most advanced emergency medicine technology available.
It’s a long ways removed from what Dr. James Hansen found when he first walked through the hospital’s emergency room a quarter-century ago.
“Back then, physicians who wanted to do emergency medicine were looked on as being a little strange,” Hansen said. “The focus back then was on primary care.”
Hamilton’s emergency room wasn’t staffed in those days. When someone was seriously hurt or fell deathly ill, they had to wait inside an almost empty room while a local doctor was located.
“It was just a room with a gurney, a cabinet with some Band-Aids and a telephone,” Hansen said. “I think the phone was there to call for help. No one was there until a patient showed up. There was no registrar. I don’t know who even noticed that there was a patient.”
Hansen staffed the emergency room Friday through Monday by himself for the first five years. When his patients didn’t have enough money to pay for his services, they paid their bills with cords of firewood or in sweat equity.
“One time a man paid me with a ton of wood pellets,” Hansen said. “He’d broken his arm and didn’t have any insurance. He had a wood pellet mill and he dropped off a ton for me, which I had to shovel all through the winter.
“I still bump into people in the ER who tell me things like how they remember coming out to my place and splitting 10 cords of wood to pay their bill,” he said.
Over the years, Hansen saw people’s expectations of emergency care grow and the hospital respond by adding staff, equipment and space.
“The standard of care has improved and so have people’s expectations,” Hansen said. “Now, if you can make it to the emergency room alive, you probably won’t die. It’s rare that if people make it here that they die.
“People have come to know the value of emergency care,” Hansen said. “They see it on television - on shows like 'ER.’ People’s expectations have changed. They know they have a good chance if they can just make it here.”
That shift has been dramatic.
“Twenty-five years isn’t that much time to go from an almost insignificant space to what will be the major entryway into the hospital,” Hansen said. “The emergency department has become an important face of medicine for the hospital.”
Hansen isn’t the only Hamilton physician who has seen dramatic changes in his tenure here in this small town.
Dr. Walker Ashcraft moved to Hamilton in the fall of 1968 following a stint as an Air Force surgeon.
“In those days, you were expected to do everything,” Ashcraft said. “There was no such thing as referring general surgery cases to a specialist. We did most of our general surgery, OB work and primary care.”
Back then, physicians depended on their experience and intuition and less on technology. There were no CT scanners or ultrasound devices. If something mysterious was ailing a patient and a doctor couldn’t figure out its origin, the next step was often an exploratory surgery.
“If you couldn’t figure it out, you might order an exploratory laparotomy,” Ashcraft said. “You open up the belly and take a look to see what’s going on in there. ... That’s a term that’s no longer used. That procedure is no longer done.”
New technological wonders allow physicians to look inside a person’s body from almost every angle imaginable. And non-invasive laboratory tests can often detect a disease in its earliest stages.
As a result, people are living longer and more productive lives.
Ashcraft, who turned 70 this year, has seen his patients grow older.
“I’m seeing a lot more elderly people,” he said. “People are just living longer and for the most part, they’re healthier. Expectations have changed.
“When I first came here, when I’d make my rounds and see a little old lady just lying there in bed, we’d all just do what we could to make them as comfortable as possible,” he said. “There were no high expectations for them.”
Now, Ashcraft said, people want to live forever and not stop doing the things they enjoy.
“People are aware of the implications of exercise, cholesterol and weight,” Ashcraft said. “People take all of that a lot more seriously than they used to.”
When Ashcraft looks toward the future of health care in this Montana valley, the issue most worrisome is the fact that new primary care physicians are getting hard to find.
“People just don’t seem to want to do this anymore,” he said. “It used to be that doctors with a general practice worked themselves literally to death. They were on call every other night and they did everything.
“It wasn’t uncommon for doctors to die in their 40s and 50s,” Ashcraft said. “People going into medicine these days want to enjoy their lives. They don’t want to be on call as much.”
As a result, many new physicians focus on specialties where they’re well paid and not required to be constantly on call. New primary care doctors also are looking for new ways to do business that keep their workload manageable.
“The problem is they’re just not making as many primary care doctors any more,” Ashcraft said.
A loss of primary care physicians forces people to seek out specialists or wait until they’re sick enough to go the emergency room, he said. Under both scenarios, patients lose the connection of dealing with a single physician who knows them best.
“If a patient goes to a lot of different physicians for all their different ailments, then no one sees the whole picture,” Ashcraft said. “Primary care physicians try to be that one person who knows the whole picture for patients.”
Hansen said getting people into the appropriate level of care is a challenge for today’s health care providers.
Too many people use the emergency room as their primary health care facility, he said.
“Emergency departments aren’t the appropriate level of care for routine illnesses just as primary care isn’t the appropriate level of care for someone having a heart attack,” Hansen said.
While plenty of challenges loom for the future of health care, both 66-year-old Hansen and Ashcraft say they’re not ready to ease into retirement.
“I don’t have any plans to quit any time soon,” Ashcraft said. “As long as I can keep doing my job and I’m healthy, there’s nothing else I’d rather do.”
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