Rotation roundup: rural family medicine

I must confess I didn’t really like writing this post.  Reminds me of how much I’ve enjoyed this past month in Bow Island and how very sorry I’ll be to journey into the unknown realm of obs/gyne on Monday.  Bow Island is familiar now; I know most of the people who work in the clinic and hospital, I know I get along with the docs and the staff, I know most of the repeat patients… and now I’ve got to ditch all that in favour of 26-hour shifts and catching babies.

That sounded rather grim.  Let me rephrase.

Bow Island was awesome.  I’m about to tell you why.  Then tomorrow I get to try something totally different and (possibly) equally awesome.

The where:  Bow Island clinic and hospital, one day in Medicine Hat for maternity clinic

The good:  I’ve already touched on a couple of points.  Pretty much everyone I worked with was fabulous and kind and patient with me.  There wasn’t a single incident where I was ignored or patronized due to my inexperience.  It really was almost shocking to see how every doc quite liked teaching and hearing from people who have more book smarts than clinical acumen.  There could be an entire paragraph gushing about how even the locum was so great in teaching me how to tighten up my suture technique and how I was allowed to help with every emergency and every weird case… but I won’t write that.  Because frankly, it would be embarrassingly long.  And I would have to mention the lovely surprise I got on my final day.  But I’d like to leave that a secret in case any of you are heading that way…

An unforseen bonus of working rurally was the fact that I was given room & board with a local family.  (Note: this will only happen if a resident is in town, since they automatically get dibs on the apartment in town.)  I’d thought this might mess with my work groove and moments of antisocial behaviour… but it turns out that it worked perfectly.  When I really needed to study, I could hang out in the basement and plug into my iPod, same as in my apartment.  But when I was having lunch or dinner, there was often someone there to chat with and decompress after long days.  This family has been hosting med students for many years, so they’re quite accustomed to the weird habits and comings-and-goings at odd hours.  Also, the missus is an awesome cook.  Major bonus.

I’d heard that rural family is quite hands-on, but I didn’t realize quite how much.  I can’t even count the number of fingers and faces and ears and arms that I’ve stitched up.  Draining abscesses, making casts, airway management… you get to do it all.  In fact, most of the preceptors will insist on you trying everything.  I hadn’t realized how immensely satisfying suturing is.  [sigh]  When you pull those knots nice and tight, the skin puckers beautifully, and the bleeding stops immediately… it’s truly wonderful.  But not in a creepy, Dexter sort of way.

And again, the scope of practice is huge here.  I’ve never worked in an ER before, so it was nice to do it rurally where you see lots of subacute stuff and only the rare real emergency.  Plus there’s all the aforementioned practical stuff, regular clinic, the occasional maternity clinic in Medicine Hat, working in Foremost… you get the idea.

The not-so-good:  The biggest thing really is the lack of equipment and testing available.  This may shock urban docs, so prepare yourselves… They don’t even have an ultrasound.  [gasp!]  Sure, there’s a fetal doppler for heart rate and a bladder scanner, but the only real mode of imaging is x-ray.  And it’s not even a 24-hour thing, you’d have to call in a tech if you wanted something at night.  So you very much have to rely on your clinical impression and whatever limited bloodwork is available to you (no cultures, here, folks).  Even then, I’m loathe to put this on the “not-so-good” list, because it’s simply a different way of practicing.  Sure, I’d feel a heck of a lot better if I could prove that somebody has gallstones right away, but most people are going to present like they’re supposed to.  I’ve had to learn to trust my diagnosis, and when that fails, my instinct and my sick-or-not-sick radar.  Usually I’m right, shockingly.  And the times that I’m not or I don’t quite believe myself, there’s a great support team there to give me another opinion.

And that’s it.  Really not much else I can come up with for negatives.  Good sign, right?

Interesting fact:  The ER in hospital is new and absolutely beautiful.  The acute care wing was built in 1953 (if I remember correctly) and is the oldest standing hospital wing in Alberta.  Huh.

The verdict:  I’ve got to do this again sometime.  It’s awfully nice to know that, should I choose to do an elective in rural family medicine, I know there’s a place where I tend to get along with everyone and I’m familiar with the site.

Another roundup, another rotation, another month done.  From here I venture into that shadowy land of pregnant ladies, newborns, and hysterectomies.  See you on the other side of obs/gyne…

 – Atalanta



Filed under Medicine

2 responses to “Rotation roundup: rural family medicine

  1. Linda Johnson

    Jessica, I love your story about Bow Island. There is something to be said for small town medicine. I also want to know what your surprise was on your last day….please.

  2. You definitely got the rural experience! Having worked as a rural nurse, I can relate to pretty much everything you describe. In fact, for nursing students I recommend they try rural nursing for a year or two, in order to build confidence and skills while working with lower-acuity patients. I’m not sure I would recommend it for a new medicine grad, though, simply because of the responsibility involved. You’re absolutely right about having to really trust your diagnoses. Plus, you have to know a lot about alternative medications and treatments for those times when somebody comes in on Friday night (pharmacy is closed until Monday) and the recommended 1st-line drug for their condition isn’t available in the hospital. It does, however, really help you hone your clinical skills because you simply don’t have a team of different professionals to help you.

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