In Modern Healthcare this week there is a good article on telemedicine and psychiatric services. However one line irks me a lot!
Half of the counties in the U.S. do not have a psychiatrist or an addiction medicine specialist, new data from George Washington University shows.
County is an incredibly bad unit of analysis. There is a county, Kalawao Hawaii, with less than 100 residents. There is one county, Los Angeles, with over 10,000,000 residents. But when we analyze things by county, we implicitly say that Kalawao and Los Angeles counties are equally weighted and equally important.
That is absurd in general. It is effectively the same as looking at the land area map of the United by Presidential vote so we equally weigh areas that have more cows than people and mid-town Manhattan.
The relevant question is can people readily access appropriate care within reasonable time and distance parameters?
Yeah, there are a lot of fuzziness in “appropriate”, “readily”, “readily access”, “reasonable”, “Time and distance parameters” but if we’re worried about psychiatric services not being readily accessible, I would be far more freaked out if there is no one in Los Angeles County able to take a patient than if there is no one in Kalawao County.