A Week in Rural Medicine

On Monday I drove down to Bandon, OR for a week-long rural family medicine experience. My purpose in doing so was to get a better idea of the breadth of practice family docs can have. My preceptor for this week, besides having her own family practice, works in the ER, follows her own patients in the hospital, and at times has assisted in surgeries, delivered babies and been a hospitalist. She has a beautiful house right on the bluff overlooking the ocean—when I drove up, I was floored at the gorgeous view she has! Tuesday I spent in clinic with her—she primarily has older patients since she stopped doing OB. We’ve talked a lot already about how the healthcare system in is big trouble and how many docs (including her) are fed up with insurance companies and skyrocketing malpractice insurance. Over the past few days I have also been once again exposed to the joys and challenges of serving an underserved population. Bandon is a touristy retirement community mostly, and though it has a small hospital, does not have many of the resources that a large community would have. The ER can only deal with small trauma, they have no surgeon currently, and it seems like people work super hard to keep things going. Yesterday evening I had the opportunity to follow my preceptor as the on-call doc (the only one) for the ER. We've seen some exciting cases– we saw a lady with severe asthma, a woman with a shattered elbow, a woman with 6 broken ribs and then an older man with a pneumothorax. Although I didn’t think I knew anything, maybe I have learned something after all about medicine! Overall, it was a pretty interesting experience, and I’m kind of interested in learning more about emergency medicine.

The next morning we went to the house for breakfast, and rode over to a nearby city so that I could watch a surgery—an inguinal hernia repair. That was pretty interesting, although I was nervouse that I was going to faint because it has nearly happened before. Well…the surgeon had me scrub in and go right up to the table. We were already past the skin and superficial fascia and I was holding the retractors and peering in when all of sudden I knew my body did not want to be there. I didn’t faint, but I felt that yucky clammy feeling, so I went out for a minute and later came back in just to watch. I made it through the rest of the surgery fine, but I was pretty tired by the noon. I think I havne’t had much chance or taken the chance to rest since coming back from Indonesia, so I wonder if I am actually recovered from all that—with the wedding preparations, the only time I had alone was basically in the shower! So later today after a long nap I headed out on the beach and enjoyed a nice walk.

I’ve been learning more about what it’s like to practice in a small town where your patients are your friends too, everyone says “good morning,” and people are more intimately connected. I kind of like that. However, there is some loss of separation between work and home, and there are fewer people to cover for you for vacations and such. In talking with the surgeon (actually, he talked at me), he strongly emphasized “diversifying” outside of medicine and how medicine is changing so much with people moving more and more into high specialized practices and technology taking over. It’s interesting, and I realize in medical school we really need to get more training in how to run a business. I’m not real excited about the business aspect of medicine, and I think balance is very difficult but important because docs are under a TON of stress—many falling into substance abuse, alcoholism, obesity…but I think there’s a big something, no, rather Someone all these people are missing. That is, Jesus. True, even Christians have to be reminded to balance their lives and make wise priorities. They too can be trapped into materialism. I think having the hope of Jesus in our lives makes all the difference in the world on how we can make priorities and go on when faced with difficulty after difficulty. There’s wisdom in what this surgeon is saying, but maybe it won’t be as glum as he says because of what Jesus does in my life—especially in the areas of strength, contentment and true happiness. Oh, I haven’t “arrived”—I am way too young to really know what I’m talking about, but I believe having a foundation built on the Lord will give me endurance and hope as a physician.