Rural Medicine – Not Just Runny Noses

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.

4 Responses to “Rural Medicine – Not Just Runny Noses”

  1. 1 Jewell Burke May 7, 2012 at 1:50 pm

    My kind of Doctor! If I could just find him in this area!!!!!

  2. 2 Alex Spencer, MBA (@spenceralex) May 8, 2012 at 12:26 am

    Great post! So glad I stumbled onto this blog.

    I aspire to be similarly talented country doc, as I wish I had while growing up in the boonies.

    Thanks you Sir!

  3. 3 Melanie Morton June 13, 2012 at 1:22 pm

    I am studying to be a Family Nurse Practitioner and this is the type of care I want to be able to provide…where I build relationships, do my best to understand what’s really going on, provide the care when I can, and get them to the right care when I can’t…oh, and I can’t forget…know that I can’t fix everything…I enjoy your blog!

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Bookmark and Share


contact @

RSS A Country Doctor Reads:

  • What Can Doctors Learn from Teachers?
    An article in The New York Times about Doug Lemov’s book “Teach Like a Champion“ made me think more deeply about what to do with outcomes measures in health care. Lemov has analyzed how successful teachers teach, measuring how long they wait for students to answer questions to how much eye contact they have to […]
  • The Difference Between Care and Cure
    My wife ordered a book a few weeks ago by Henri Nouwen, called “Bread for the Journey”. It was published posthumously and contains daily reflections. Nouwen is perhaps best known for his writings about the “wounded healer”. This morning over coffee, Emma asked me to look at today’s reflection, titled “Care, the Source of All […]
  • What Will the Doctor Do?
    In the near future, doctors will be the link between the science and humanity of medicine. They will listen and guide, while computers do the diagnosing… Oncologist James Salwitz writes about the Federal Health IT Strategic Plan in a nice piece on The Health Care Blog: “The doctor will no longer be the final fountain […]
  • The New Paternalism
    Doctors were once accused of being paternalistic. Today there is a new paternalism in health care: insurance companies are more and more heavy-handedly forcing doctors to disregard their own clinical judgment as well as their patients’ wishes by imposing “quality” standards through “pay-for-performance” financial rewards and punishments. Pamela Hartzband and […]
© A Country Doctor Writes 2008-2015. Unauthorized use and/or duplication of this material without express and written permission is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given.