"Good morning officer. I'm Doctor Costrini and I am making this house call to see if I can pass you."

Startled, then humored, he was kind enough to stop the house, let me pass, and continue my journey to Claxton. That was the only time I have made a moving house call. Years later, my nurse still recalls the image of my running along side the moving house as I discussed the dynamics of this particular medical situation with the house-riding constable.

Rural areas are characterized by the sociologists, city planners, and politicians as regions of lower population density, remote from larger towns or cities, generally dependent upon agriculture and having lower per capita income than cities. Health workers correctly associate rural areas with lower access to care, a 20% uninsured population, alarming rates of hospital closures, and shortages of local primary care and subspecialty physicians. As the young people continue to move to the cities in search of security and success, rural America is becoming poorer, aged, and in even more critical need of health care services. Government efforts over twenty years to secure health care services for many rural areas of Georgia have failed and other means must be found. Physicians from the cities regularly travel to rural clinics to treat patients. This is easier than having the patients, many of whom are old and sick, travel to the city for care. Also when care is given in the local hospitals, that care translates into financial support and security for that rural hospital. Quite unlike urban hospitals, the rural hospital is usually a major employer and an organizing social force for the community. The closure of a rural hospital should be recognized as a truly tragic community event that compromises health care, community identity, and the financial life of the town. Doctors who live and practice full-time in rural America are heroes. Doctors who travel to the towns are good soldiers in the fight for rural health care. As communications evolve, telemedicine is being viewed as a possible means of providing advanced health care to rural America from urban medical centers.

Using TV monitors and health care workers communicating with each other, patients may be evaluated without doctor or patient traveling a significant distance. One of this country's most sophisticated telemedicine experiments comes from the Medical College of Georgia. The results are hopeful but not conclusive that quality care can be provided to rural Georgia in a financially sound manner. At the present time, most insurance plans and Medicaid will not partially or fully cover the costs of a telemedicine care visit. Until federal and private insurers develop telemedicine payment plans, telemedicine will not likely get beyond the stage of medical clinical research. This is an election year. Ask the candidates from Texas and Tennessee their positions on funding for support of rural medical care and telemedicine programs. Georgia needs both. For now however, as long as there are rural patients in need, small towns requesting our help, and physicians willing to travel, be understanding when you call for an appointment with your city doc. When you are told he is "out every Wednesday," it is no longer likely that your physician is on the golf course. He is probably making a moving house call on his way to rural Georgia.