Dear Editor,
We often measure access to healthcare by how close a hospital is, how many specialists it employs, or whether a patient can eventually obtain an appointment. My family’s experience taught me that access means something more: Can a patient get the care and communication they need when they need it?
My husband suffered a serious posterior-circulation stroke in October 2025. Because Dartmouth Hitchcock Medical Center (DHMC) is a comprehensive stroke center, we expected that specialty follow-up would be timely and that the system would help guide his recovery.
Instead, we were told that the specialty service was “booking out.” We waited months for an appointment. In the meantime, we had no meaningful way to communicate directly with any neurologist, including the physician who would eventually be responsible for his neurological care. His first specialty appointment was approximately four months after his stroke.
Then we experienced a striking contrast.
A referral was called in to Massachusetts General Hospital. Within three weeks, an appointment was offered. Once the appointment was established, we also had access to Patient Gateway, allowing immediate communication with the neurologist and care team before the visit.
And this was not an isolated experience. When we sought care through Rutland Regional Medical Center, Northeast Eye Center, Alice Peck Day Hospital, Weeks and Gowen Physical Therapy, and Mount Ascutney Hospital, referrals were met with prompt responses and appointments within days or weeks, rather than months. Everyone we spoke with at those agencies responded with caring, empathy, and a focus on alleviating our concerns and answering our questions.
The difference was not simply geography or technology. It was responsiveness.
Mass General is a major academic medical center, but Alice Peck Day and Mount Ascutney are regional hospitals serving the same general population. Yet each demonstrated that a referral can be acknowledged, acted upon, and converted into timely care. At DHMC, we were left waiting for months because the service was “booking out,” without providing access to the physician during that interval.
But there is another troubling dimension to this experience. DHMC is a teaching hospital. Medical students, interns, residents, and fellows learn not only from textbooks and lectures, but by observing how the healthcare system responds to patients. What lesson does a system teach when a patient with significant neurological deficits can be told to wait months because the service is “booking out”?
Patients should not have to accept delayed care simply because a medical center is busy. Being busy is a reality of healthcare; making patients bear the consequences of that reality is a choice.
Teaching hospitals have an obligation to model the professional values they expect future physicians to carry into practice: timely attention to patient needs, continuity, communication, clinical responsibility, and advocacy for patients who cannot navigate the system themselves. If trainees repeatedly see patients waiting months for specialty care, unable to communicate with a physician, while the explanation is simply that the service is busy, what are they learning about the standard of care? The lesson should never be that “busy” is an acceptable reason to stop being accessible.
For a patient recovering from a stroke, months are not an insignificant amount of time. Neurological recovery, rehabilitation, secondary stroke prevention, and evaluation of persistent or changing symptoms all depend on timely access to appropriate care. Medical research shows that rehabilitation therapies during the first few months after a stroke have the potential of significantly improved outcomes. But we were still waiting for a neurologist during that period – no functional evaluation, interventions, or therapy.
This experience made me question what we mean when we say that New Hampshire has “world-class healthcare close to home.” Having highly qualified specialists in a medical center is not the same as having access to those specialists. A patient can live minutes from a comprehensive stroke center and still face a four-month wait for meaningful specialty care. Meanwhile, referrals to five other healthcare organizations – both academic and community-based – were addressed within days or weeks.
We should not confuse having an appointment with having access to care.
True access means timely appointments, communication with the clinical team, continuity, and a system that remains engaged with the patient while he or she is waiting.
This matters particularly for patients with serious or time-sensitive conditions. A waiting list is not simply an administrative inconvenience when the patient has unresolved neurological deficits and unanswered clinical questions. Patients should not have to choose between staying close to home and getting timely access to the medical care they need.
If our healthcare systems are going to compete on the promise of “world-class care,” perhaps we should measure that promise by a simple question: When a patient needs a specialist, how long does it actually take to reach one, and what happens to that patient while they wait?
That is what access to healthcare should mean.
Sincerely,
Susan Boyer DNP, RN, FAAN
Weathersfield, Vt.