Rural Doctoring

Rural Hospitalist Tip #1: It's Just Like Falling Off a Bicycle

So I've been having one of those funky runs of call in which it seems everyone crashes on my watch. Patients who were as stable as can be on the previous shift suddenly become obtunded or oxygen-starved the minute I've gotten sign-out and the other hospitalist(s) have left the building. This happens to everyone--after all, the patients are in the hospital for many reasons, one of which is the risk of getting sicker--so I'm trying hard not to take it personally.

Brave New Blog

During my recent silence I spent a lot of time thinking about the original vision I had for being a rural family doctor. In this vision, I provided full-time primary care, including inpatient coverage for all my patients, whether they were kids, old people, or laboring women. I was going to be a salt-of-the-earth, old-fashioned family doc who was present for birth, death, and the messy interval between the two. For a brief period--about a year--I lived a close approximation of this vision, and although it was a rewarding and happy time, various factors ultimately led me to transition to full-time hospitalist work.

Bigger & Crazier Than I Am

I mean the Pacific Ocean, and I mean in a good way:

This is why I need to make a greater effort to crawl out of the hospital more often, and remember why I moved all the way to Rural.

Why I Live Here

A commenter recently asked why I live in California, if the cost of living is so high.  I don't really have a firm answer to this question, but here's one reason:

This is the view from Highway 1 just 20 minutes north of where I live. I love the hectic, noisy, untrammeled coastline up here, and I love the way the ocean crashes against forested mountains. You should see it in person, you really should.

The End of Old-School Family Practice

Via the Healthcare Entrepreneur, today I learned Dr. Steve Harrison is closing his practice in King City, CA. (Image credit.)

King City is a very small agricultural town in central California. I've never been there but the residents in my program used to take care of King City's patients when their own rural hospital, Mee Memorial, couldn't provide needed services. The people of King City and surrounding environs don't have many options for obtaining health care except for a publicly-funded FQHC and Dr. Harrison's private practice.

Becoming a Rural Doctor, Part 8: Welcome to Your Rural Community

In the last post in this series about becoming a rural physician, I'm going to discuss joining your new community. By this point in your training, you've already explored the rural experience in medical school and residency, and you've also found a job in a rural community you like. But once you get there, how do you start life and medical practice?

A young professional can find dozens of how-to guides on how to hire movers and pack boxes, how and when to cancel utilities at your old home and install them in your new one, and how to forward your mail. But there's more to moving than relocating your coffee maker, your garden gnomes and your lava lamp collection. You have to become a part of a new community, and for a new doctor, there are some special tasks to complete and considerations to make.

Becoming a Rural Doctor, Part 3: Medical School

In the last two posts in this series on education and training for potential rural doctors, I have emphasized generalist education and presented a basic socioeconomic portrait of rural versus urban practice. Today's post will take a look at applying to, financing and attending medical school for the potential rural doctor.

Becoming a Rural Doctor, Part 2: The Generalist's Mind

When I think of rural doctors, I think of family practice. Part of this is training bias, because I am a family doctor, but this bias is supported by surveys which demonstrate that a significant number of rural communities would be medically underserved if it were not for the presence of family physicians:

"A recent study from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care indicated that, if family physicians were removed from the 1,548 rural U.S. counties that are not Primary Care Health Personnel Shortage Areas (PCHPSAs), 67.8 percent of those counties would become PCHPSAs. On the other hand, removing all general internists would make only 2.1 percent of the counties PCHPSAs, and only 0.5 percent would become PCHPSAs without pediatricians or without ob/gyns." (Fryer et al., 2001, cited by an AAFP Position Paper)

In this post series, I will emphasize the family practice model of medical training as an approach to preparation for rural practice. I do not mean to imply that other primary care specialties--such as internal medicine, pediatrics or OB/GYN--have no place in rural communities. Quite the opposite, in fact. My job in Rural, CA. would be so much more difficult if I did not have the support of the other primary care specialties. I hope this post series will be useful to medical students and residents who are training in those specialties as well, even if the content tends to veer towards family practice. I will argue that it is the generalist's mind, rather than the specialty, which will suit a doctor for rural practice.

Becoming a Rural Doctor, Part 1: The Rural Landscape

I've been reading the blogs of medical students and residents with some interest lately.  Their stories about the trials and tribulations of learning to stay awake night and day and how to deal with cranky attendings and even crankier patients take me back to the bad old days of my own residency. I've also had a few glimpses of the osteopathic medical students (OMS) who are rotating in Rural, CA. as they assume their new roles as clinical learners. Hearing about and witnessing these experiences makes me reflect on my own training and the steps I took to become a doctor in a rural community. This new post series is going to examine these steps in more detail, and I hope it will be helpful to trainees who are considering a career in rural healthcare.

Rural Sights: A Prince in the Making

From last year's garden, a sweet tenant found in the heart of a growing bok choi:

No garden this year, alas. Too much hospital work to spare time to dig into the earth, a sure sign of overwork.

Rural Sights: Our Fearless Start-Up Company

You probably won't see this sign on a sandwich board in the big city:

Rural Sights: Making Hay

It's hay season in Rural! All around me, my neighbors are cutting and baling hay for storage:

This grass hay will keep horses and cows happy through the winter. Today, however, it is not making me happy at all:

Ah well.....Ah-CHOOOO!

Rural Sights: Bird on a Wire

Seen recently while on my way to work--I believe it is a Cooper's Hawk, but any birders out there might feel free to correct me:

Rural Sights: My Front Yard

I have a brave little orange-and-white tabby cat named Hummi.  Nothing fazes her, not even a bachelor herd of black-tailed deer.  Here she is, sauntering past a young buck:

15 Minutes of Fame: Medical Marijuana in Rural, CA.

You'd think I'd be pleased to have my neck of the woods hit the front page of the national newspapers, but with these headlines, I'd rather stay anonymous:

• New York Times: Marijuana Hotbed Retreats on Medicinal Use
• Los Angeles Times: Marijuana 'grow houses' are creating problems in Arcata, Calif.

Supermarket Adventures, Part Two

City dwellers get delayed by traffic jams.  What's holding me up these days?  The Azalea Festival Parade:

That's the main street in my town, which for about 60 minutes was overtaken by tractor-drawn floats, marching bands, and vintage car fanciers. Here's a video clip I shot on my camera.

An Open Letter to the Woman at the Supermarket

Dear Neighbor/Patient,

It was very kind of you to inquire after the state of my garden when we bumped into each other at Safeway this morning.  We haven't seen much of each other lately and I was pleased to hear your early peas are already flowering.  We waved good-bye to each other and went about our business.  Or so I thought.

Moments later, you cornered me as my food items were being scanned and asked me "What do you think about all this stuff they're saying about Fosamax?  Should I stop taking it?"  I was unprepared for such a question, because my navel oranges were bumping into the large globe artichokes and threatened to clog the upstream progress of the red seedless grapes onto the rubber rolling mat that conveys the groceries inexorably towards the bagging platform.   

My New NEIGHbor

You know you live in the country when you live next door to horses.

Here's the latest arrival: baby boy horse Scooter, only two hours old.

Oh Deer

I always wanted a house off the main road with a bit of land around it, and that's what I've got. Just to give you an idea, here's the view from my back yard: