Rural medicine is the most stimulating kind of primary care

A lot of people, many of them medical students, think that rural doctors don’t get to see many interesting cases.

The opposite is true; if you are the only doctor within a wide radius, people will come to you for help, rather than try to pick the appropriate out-of-town specialist to diagnose their problem. In this state with widespread physician shortages most specialists won’t even see self-referred patients.

Sir William Osler wrote: “The environment of a large city is not essential to the growth of a good clinical physician. Even in small towns, a man can, if he has it in him, become well versed in methods of work, and with the occasional visit to some medical centre he can become an expert diagnostician and reach a position of dignity and worth in the community in which he lives.”

Today, with UpToDate and all the medical journals of the world instantly at our disposal through the Internet, rural physicians cannot blame the size of their patient panel or of their medical community for not keeping up with the essentials in their field. Rural primary care doctors are usually the first ones with an opportunity to evaluate and diagnose our community members’ medical problems, regardless of their complexity or severity.

In situations when I feel stumped with a difficult diagnosis, I sometimes end up explaining to patients that until I understand better what the nature of the problem is, I don’t even know which specialty is the right one to refer them to, since the delineation of specialties follows disease location or mechanism rather than presentation.

For example, a person with weight loss could have an endocrine problem, an intestinal problem, cancer or a psychiatric diagnosis. The family physician is usually in the best position of all specialists to sort out which is the underlying cause.

It is sometimes quite touching when, after I have diagnosed a patient with a rare disease that only a big city or university-based specialist can manage, patients say “ah, Doc, can’t you treat me instead – I’m comfortable with you, and you’re the one who figured out what was wrong with me”.

Rural medicine, in terms of the spectrum of disease we encounter, is the most challenging and most stimulating kind of primary care medical career available to doctors in this country.

The double-booked visit with the Chief Complaint “I think I have a sinus infection” could be a brain tumor. The woman with chest pain could have an esophageal diverticulum, and the man with heart palpitations could have hyperthyroidism, an arrhythmia, a drinking problem or an anxiety disorder – perhaps even a pheochromocytoma.

It is my job to do the right thing, not too little and not too much, for each one of these patients, who trusts me with their care.

It’s all in a day’s work in primary care.

And, oh, one man with a runny nose just didn’t act right. He seemed vague with some word-finding difficulties. I had never seen a brain abscess before, but that is what he had.

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.

Comments are moderated before they are published. Please read the comment policy.

  • Robert Bowman

    Rural training before medical school, during, or after is a great way to train for any medical career – especially those most needed and most challenging.

    The Rural Physician Associates Program is the premier longitudinal rural training program during medical school with a 40 year history of training medical students in rural communities. RPAP medical students are overwhelmed with primary care after 3 months (about what medical school allows), at 6 months they reach neutral, at 9 months they really appreciate the challenges faced by those on the front lines. They are often frustrated by their 4th year of very passive training back in academia. FM, rural primary care and specialty physicians, general surgery, OB, and neonatal careers have been more likely from RPAP grads along with substantial instate care where needed. RPAP grads are preferred by residency directors.

    After medical school there are rural family medicine programs, rural training tracks, and other opportunities to spend time where physicians must known skills, procedures, their patients, their team members, and how to fill in the gaps in our health care system.

    In Japan there is a rural medical school. We can do even better in the US. At such a school candidates would prepare for 2 years working with rural physicians, train 3 years of medical school with rural physicians, and complete FM residency in the rural location – for maximal rural health care delivery before, during, and after training – by design.

  • Victor Panagiotakopoulos

    You bring me back 20 years when I had my rural training as a young doctor. Thank you for bringing me back to these nice memories!

Most Popular