Practicing Medicine In Rural Kansas Changes Med Student's Patient Perspective
Former KCUR intern Stefani Fontana, now a fourth-year medical student at the University of Kansas School of Medicine, spent last summer doing a clinical rotation in western Kansas. We asked her to keep a journal of her experiences. We’ve edited out actual names of people and places to protect privacy, but otherwise present her journals largely as she wrote them.
Part 4 of 4: Lessons learned
The decision to become a doctor is different for everyone, yet there are values and desires we share that have driven us all to the same conclusion. I took a circuitous path to medical school, but my desire to help people, to heal, to change lives, comes from the same place in my heart as my classmates’ desires to do the same.
The experiences I had in rural Kansas were worlds apart from what I pictured doctoring to be, but they implicated the same core values of healing, helping, changing lives. Rural medicine is one of the few places where true cradle-to-grave family medicine is still the norm. It’s where you’ll see your primary care doctor, who also delivered all three of your children, at the town diner, and then afterwards at the high school football game.
Because the doctor has a personal relationship with the patient, she’s able to address patients’ emotional and psychological issues, treating their unique needs and health habits, which allows them to be particularly effective health care providers. The trust and respect the patients have for the physician in turn create an environment in which the doctor sees her advice and treatment being put into practice in the patient’s everyday life.
From the perspective of a future doctor, I was envious of Dr. O’s freedom – to make her practice what she wanted it to be. All of her patients got 30-minute appointments, not the 15 minutes I’ve seen in larger places. She said it was because she never wants them to feel rushed. That personalized the practice of medicine for me. She’s taking a financial hit, essentially seeing half the patients that most doctors would, because she values her relationships with her patients.
While I’m sure other doctors would be willing to do this, the institutional demands of most doctors’ practices in bigger cities prohibit them from exercising this choice. I’m sure many doctors would be jealous of her ability to give this much time and attention to each patient.
Another feature of rural medicine that stood out was the continuity of care. When your obstetrician becomes your pediatrician and then is the doctor who meets you in the emergency room when your little one falls off the trampoline and splits his chin, your child is more comfortable with the person stitching their chin up, and the parent knows the doctor and feels more comfortable as well. From the perspective of the health care provider, it makes treating that emergency room patient easier because you know every aspect of that patient’s medical history.
When I am in an emergency department in Kansas City, almost every patient is new to me, so I spend 10 to 15 minutes searching through their chart trying to make sure I know all of their diagnoses, medications and recent surgeries – anything that would suggest why they’re in the ED. One of my biggest fears is missing something in a complex patient because I don’t know the patient and her complicated medical past.
The beauty of practicing in a rural environment is that if the patient doesn’t go to the ED doctor as her primary care physician, the ED’s doctor partner probably is. A quick phone call will tell the ED doctor everything he or she needs to know.
Another unique aspect of rural health is the intellectual challenge it presents. Everyone at the hospital and clinic was practicing at the top of their license, doing procedures and making diagnoses which, while they were qualified to do them, normally fell within the domain of specialists. The breadth and depth of knowledge that these doctors, nurses, physician’s assistants and therapists had to keep at their fingertips was astounding.
Spending nights in the emergency room was probably the most fun I’ve had in medicine. We weren’t always equipped for what came through the door, and we had to improvise with what we had. I remember one night going through a patient’s allergies, realizing he was allergic to all of the medicines we would usually use for the bacteria he was infected with, and feeling proud of myself when I suggested a medicine that could work for him.
“This isn’t KU Med,” the doctor had said to me. “We don’t have those fancy, expensive antibiotics.” This forced us to be resourceful in repurposing what we did have to function as needed. I can only hope my future job challenges me in such an interesting and rewarding manner.
Final takeaway: The dedication that the doctors had to their patients was inspiring. They never fully took a night off, they were always unofficially “on-call.” I remember one night a young boy came into the ED who’d broken a leg in football practice. The orthopedic doctor in a city 30 minutes away was called, and he dropped everything he was doing to come fix the leg. Most doctors recognize that our lives will always partially belong to our patients. But the dedication I saw from the doctors, the way they accepted the weight of being the only source of health care for the community, taught me what dedication truly means.
Spending time in rural Kansas changed the way I think about the practice of medicine. It certainly changed my thinking about rural medicine. My hope is that I can show my patients the same respect and dignity that Dr. O and the other providers showed their patients.
I hope I can always treat the whole patient, as the saying goes – that is, take into account their emotional well-being and psychological well-being, and make treatment plans that fit their habits rather than build around the habits of an ideal patient, which can set patients up to fail at achieving their health care goals.
Spending time in rural Kansas also taught me resourcefulness, and commitment. It drove home the gravity of one’s commitment as a doctor. While it’s not likely I’ll become a rural doctor, my experience changed how I practice for the better.