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Alan Lindemann: A Rural Obstetrician’s Perspective on Healthcare

It’s a rural obstetrician’s perspective on healthcare from Alan Lindemann on this episode of the Perspectives on Healthcare podcast with Rob Oliver. Alan is from North Dakota. He lives in a county where there are 2 people for every square mile, that’s pretty rural. Alan Lindemann is a member of the Baby Boomer Generation.

Here are 3 things that stood out as Alan Lindemann shared a rural obstetrician’s perspective on healthcare:

  • The primary word to remember when thinking about quality healthcare is access!
  • Overcoming the barriers to access takes place one practitioner at a time and one patient at a time.
  • The model needs to be adjusted to include mental health as a component of prenatal care.

You can connect with Alan Lindemann using the links below:


Here is a transcript of my interview with Alan Lindemann:

Rob Oliver: Thank you and welcome to another episode of perspectives. On Healthcare. Today’s perspective comes from Alan Lindemann. He is a physician from out in North Dakota he specializes in obstetrics. He is a member of the baby boomer generation. Alan, welcome to the podcast.

Alan Lindemann: Thank you very much. I appreciate it.

Rob Oliver: Absolutely. So can you tell me a little bit about yourself and your role in healthcare, please?

Alan Lindemann: Well, I was born in North Dakota went to medical school in Grand Forks, residency in St. Paul, and Minneapolis, and for it, except for eight years. I’ve lived in North Dakota, I had a big O B practice in Fargo, which is our biggest city. And I was very busy there, I had died in the first months of my private practice. I had 46 babies. And in my whole life of being an obstetrician, I’ve had about six thousand babies and no maternal deaths.

Rob Oliver: Wow, very, very cool. I would imagine. Okay. Maybe help help my listeners. Understand this. North Dakota seems like, pardon my bluntness on this, the godforsaken middle of nowhere. Can you can you talk a little bit about what? It’s like being a doctor when you’re … you don’t have a number of those big cities close. I’m in your nickname is the rural doc, right? So talk to me about, what it’s like, being a doctor in Rural America.

Alan Lindemann: Well, I’ve been here for about 6 years in Elgin, and this is Grant County there. Two thousand is there, two people per square mile in Grant County. So we are the least populated county in North Dakota. So we have 85 miles to go to the next biggest town. So we always had to worry about, how are we going to get our emergency patients to Bismarck, which is our closest Big Town. So a lot of these people, if we have to take care of a little bit more than we’d like to, but for the most part, I think we’ve done a good job of getting them to Bismarck, that’s either by helicopter or by ground ambulance. So it does mean that we have to really exercise good judgment in the how we’re going to get people out of here. And of course, COVID hasn’t helped. There was a long time when we couldn’t move anybody out of here.

Rob Oliver: Yep, I would imagine so that Living in living close to a city. I live near Pittsburgh Pennsylvania. And there was that feeling of isolation where everybody, our houses are all close together but we’re all still isolated. I would imagine that there’s a somewhat of a feeling of isolation in general. And then when you’re doing some quarantining that isolation becomes further, compounded what’s your thoughts, there?

Alan Lindemann: Actually my wife and I enjoy being isolated. If you could look out our front window, which I said, when we bought the house at this is worth three psychiatrists, it’s a beautiful view and all we can see is maybe a farmhouse far away and we can see trees and we can see weed. And so, we’re by ourselves out here. And so, will quarantine, we quarantine anyway.

Rob Oliver: It’s funny that you say it that way, because in that, in that capacity isolation is actually What what you were seeking when you moved it to where you are rather than the other way around, what does Quality Healthcare mean to you?

Alan Lindemann: Well there’s one word to remember and it is access access is very important if you look at say for example, the countries that provide access to prenatal care like the Scandinavian countries. Their maternal mortality rate is two or three or four hundred thousand in our country where we deprive people of access in the effort to control costs. We have a maternal mortality of approximately 23 per 100,000 for Caucasians. It’s about 40 per 100,000 for Native Americans and Native alaskans. And it’s about, 55 400,000 for blacks. So, this is denied access.

Rob Oliver: So what would be your proposal for a? How do you address that in our in our culture and it with the parameters that we have in our Healthcare System?

Alan Lindemann: We do have a lot of barriers to access these include Medicare. Medicaid many CEOs. Many Health insurances of the American College of Ob-Gyn at most health insurers and medical malpractice. So those are the barriers. How do we overcome that? Well, I have tried to do that one patient at a time in rural North Dakota and that’s all the more I can do except for talking to you and having the websites and trying to narrow the gap between two little access and enough access.

Rob Oliver: I would imagine that the cost of prenatal care is is fairly insignificant when it comes to what it compares to some of the complications that can arise from poor prenatal care. What are your thoughts there?

Alan Lindemann: Well unfortunately we have the most expensive prenatal care in the world. We are cares twice, but it isn’t it. The cost is twice but it is in Canada and they have results that are twice as good. So we have a problem with access. So one thing at a time, And informing people about access. I think is the most important thing that I can do, this is like mad, you know, 60 years ago. Nobody really understood what Mothers Against Drunk, Driving was 60 years ago. And nobody really cared about not smoking 60 years ago. So, here we are trying to wage this campaign for access to Medical Care.

Rob Oliver: Got it. Can you give me an example of Quality Healthcare?

Alan Lindemann: Well certainly access to prenatal care is. One of the things that would be quality. We also have a problem with what kind of prenatal care we give, for example, we have what I call the preeclampsia model which is where you check blood pressure. You check your in your check, reflexes you measure the mother’s fundal height. But we are missing a very important part and that is mental health. So in order to really start dealing with mental health issues, we need to have a mental health model, which means that we need to understand how our families work during prenatal care. And what they’re going to do when they go home, I do have one example of that years ago. When I was a resident we could keep patients in the hospital after delivery for 3 or 4 days and we could send them home when we thought they were ready. And rhadamant does a mother, his mother and father know how to take care of this baby is a milk coming in. Can the baby breastfeed or bottle feed or whatever? So we had the option of sending them home when they were ready today, it’s a one-day wham-bam-thank-you-ma’am and their many problems with that one of their problems. Is that two mothers? We’re in for 24-Hour, have twice as much failure to thrive at 6 months as a mothers who are in 43 days with their cesarean sections. So there is a down side for patients and there is an increased costs by trying to save money.

Rob Oliver: Interesting. You when you were talking about prenatal care, one of my thoughts was prenatal nutrition and you went in a different direction than what I was expecting. So there’s there is the medical side of prenatal care. There is the psychological element of prenatal care and then there is the name of the familial aspect of it. And then there’s the nutritional aspects and it really sounds to me like what you’re looking for, is a holistic model of care. Is that accurate?

Alan Lindemann: That certainly is accurate and certainly talking about what to eat, and how to eat, is one of the most important things we can do in prenatal care. As matter fact, that’s one of the things we talked about on our website is how to eat.

Rob Oliver: Got it. What do you wish people understood about your role in healthcare?

Alan Lindemann: Well right now. I think the most important thing is that I would like to make sure that everybody knows they should be looking for access to care. And I think this is just has to start as a ground, you know a public movement because like I said the things that you’d expect to be helping I’m making it worse.

Rob Oliver: Okay, so you’re talking about like a Grassroots movement with advocacy by the public. So what are, what are some of the things that you would then say these… if you were making an advent advocacy checklist or an advocacy wishlist, what would you say? These are the top three things that I think we need to advocate for…

Alan Lindemann: Well, I would start with mental health, in prenatal courses, and of course, we need to have postpartum care for up to a year because that’s when the majority of suicides occur. This is the thing that is now more common than anything else we do In Obstetrics that is most common cause of maternal mortality. So, there’s that, and I would say, talk to your senators or Representatives, whoever you can get your hands on, whether it’s state or whether it’s Federal, they need to know that we are out there.

Rob Oliver: Got it. What excites you about the future of healthcare?

Alan Lindemann: Well, pretty much what we’ve been talking about. Another words I’m interested in increasing access also, though, there is a movement for Primary Care, which is independent of clinics. Its direct Primary Care. Now, insurance companies, don’t like it. They claim that the doctors are practicing Insurance, although the insurance companies practice medicine, but we are certainly getting more direct Primary Care available and that’s really to put the patient relationship patient-provider relationship back to where it used to be.

Rob Oliver: Okay, can you talk a little bit about what that model of direct Primary Care looks like?

Alan Lindemann: Yes, often it’s one or two doctors in a building and they will require a probably somewhere between, say 50 and $75 a month for unlimited access that is, you can call them or see them as many times or whenever they need to be seen. Also services like the labs are at cost and my medications are at crossed, so their savings for the public and there’s also a way for its positions to make some money.

Rob Oliver: It’s interesting because what you’re talking about is literally that insurance type model where folks where I have access to a doctor without that covers their regular visits. They’re not paying like a copay for a visit there. That fee is covering their access for whenever they needed. Is that what I’m understanding?

Alan Lindemann: That’s exactly correct. I don’t know exactly how the prenatal model of that would work, but I understand that for the most part, it’s a few can do $50 a month or 75, whatever, anyway, it’s cheap compared to insurance.

Rob Oliver: I’m so very interesting. Is that a model that is new and trending in North Dakota? Is that a model that’s being rolled out across the United States are because I’ve not heard of it before.

Alan Lindemann: Well, it is a model that’s being rolled out across the United States and in North Dakota, I think we have only one, direct primary care and she’s very real. She’s about 200 mi from us. So I don’t know exactly. I haven’t talked to their how this is working, but I do think it’s a way out. It’s good for the public.

Rob Oliver: Okay. Yeah, I mean it’s it’s a different model and in some ways. It sounds almost a little bit like self-insurance, but that goes back to why the insurance companies seem to be a little bit more cautious about it and seem to be, I wouldn’t wonder if they’re not in fear of a model like that. What are your what do you think?

Alan Lindemann: Well, of course Insurance like to control everything and if they really even get the idea that they’re not controlling everything, they get their hackles up about that. So yes, they’re worried about that.

Rob Oliver: Got it. What is one thing? Medical professionals can start doing today to improve the quality of healthcare?

Alan Lindemann: I would say sit with your patients as long as you can you know in an average day of say 11 hours, we have 6 hours devoted to the computer and 5 hours devoted to Patient Care. So that’s a catastrophe. So, the first thing that we could all do with that is turned it around. So you start with six hours of patient care, in 5 hours of computer. The problem with that is uphill because the computers for the most part are very difficult to manage their their user hostile.

Rob Oliver: So again I’m hearing there you’re looking for a push to make the computers easier to use less time-consuming because the last time that you have to spend with the computer the more time that you get to spend with your patients, am I properly framing that?

Alan Lindemann: You’re done a very good job of it as matter. Fact probably better than I did. But yes that’s him. Very important that we start listening to our patients, looking at them eye-to-eye and trying to understand when they leave our offices. What’s going to happen to them when they go home.

Rob Oliver: To me, I’ve always been taught that to err is human but to really mess things up, you need to use a computer… The the need for advancements in technology. Are there so that the If the technology becomes less cumbersome, then there is more opportunity for time, spent with patients, and there’s more opportunity to to listen and to hear what’s actually going on in the patient’s life. Because I’ve said this before on the podcast and I firmly believe it that the only person that truly knows the patient’s symptoms is the patient themselves and the only person that can tell you what’s going on in their life is the patient themselves. And so the only way to truly come to a correct diagnosis is to have them Express that and to listen to it, fully to make sure that you are properly understanding it. What’s your what’s your reaction to that?

Alan Lindemann: Well of course that’s exactly your preaching is a choir. I like listening to patients. I think it’s fun and I also realize it to get people to talk. You can’t endure. Another would you can’t be a little them. You can’t look like you’re trying to get out of the door or you can’t stand and talk with them with your hand on the handle of the door and you have to listen to them, you have to take some time, you do not conduct your interview with the patient disrobed. In other words, keep their clothes on, so they’re comfortable and they’ll talk to you without being afraid.

Rob Oliver: Excellent. Doctor Lindemann. Thank you so much for joining me today. I appreciate you coming on, I appreciate you giving us the perspective of a rural doc. I think that what you’re bringing in as far as access is a unique thought that I appreciate you sharing as well. Want to say, I appreciate you and I appreciate your perspective on Healthcare.

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Disclaimer: All opinions expressed by guests on the Perspectives on Healthcare Podcast are solely the opinion of the guest. They are not to be misconstrued as medical diagnoses or medical advice. Please consult with a licensed medical professional before attempting any of the treatments suggested.

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