Rural prescriptions

Idecided to sign up for a rural elective in family medicine in my third year. I imagined how grateful the citizens of the country would be if I decided to practise there because I had completed my education in a large teaching centre. It didn't take long before my illusions of being a big city doctor came crashing down all around me.

My mentor was a general practitioner who held clinics every day from 9 to 5 and then hit the mountain bike trails. Before clinic he went to the hospital to check any of his patients who were in hospital. This was a small hospital, with 60 beds, and all patients were admitted through the emergency department. Once admitted, the patient's management in hospital fell to his or her family doctor. I had to recall all my internal medicine just to manage patients on a family medicine rotation.

What impressed me most about the doctors was their extensive knowledge. They knew how to manage headaches, pigmented skin lesions, acute joint pain, depression, and well baby visits all in one fully booked day, with several drop-ins as well. What made them even more impressive was that many of them had multiple jobs.

The hospital rounds were included under the rubric of family medicine, but a lot of the family doctors also did routine emergency shifts; obstetrics, including caesarean sections; helping in the operating theatre; and even anaesthesia. My mentor liked the variety. The emergency shifts kept him sharp and up to date on the latest in emergency management, while his occasional day helping in theatre reminded him of being a medical student on a surgery rotation.

There seemed to be a lot of advantages to being a family physician in a rural area, but there were also plenty of advantages for the patients. Unlike in the big city, patients were never lost to follow-up after treatment in the emergency department or as an inpatient. The family doctors took responsibility for their care in hospital. Even when patients were discharged from the emergency department without being admitted, a note was left in the doctor's hospital mail box. There was no need to wait for discharge letters that would be months overdue; the family doctor was involved right from the start. The patients also benefited from the other jobs in the repertoire of their family doctors. Lipomata that would be left to a general surgeon in the big city were excised carefully and quickly in the clinic by the patient's own doctor. This resulted in less stress and anxiety for the patient and shorter waiting times.

Before this experience, I always assumed that bigger was better-the bigger the hospital, the better the education and the better the care of patients. But now I think we could all learn something from rural family medicine. We might be better doctors with happier and healthier patients.