The elderly patient came back to our rural hospital from a hospital in a nearby larger city after having had major surgery and feeding-tube placement. The care from the bigger hospital was superb except that the patient was getting too much nutrient and fluids and was a bit “overloaded.” Also, the family was concerned that perhaps they had been too aggressive in getting stressful surgery for their elderly mom, whose memory had begun to slip. As her physician, I cut back on the feeding-tube supplements, stopped the intravenous fluids, provided a little diuretic and did labs and X-ray for dementia. I took plenty of time with family and patient learning about their wishes should our patient again deteriorate. All agreed to emphasize comfort from here on out, and if she started to fail, we would do our best in her home hospital and not transfer her care again.
I had been that patient’s primary care doc for years. Practicing outpatient and inpatient care in a smaller town gave me the experience to see what was happening. The patient and family knew me, trusted me and appreciated the time I spent listening to her. Quality care reviewers, government oversight people and insurance companies also know the value of a well-trained rural primary care provider who not only understands how to care for complex patients, but also, knows when and where to refer when specialized care is needed. In fact, experts believe an ideal system would define a primary care provider for every person.
Unfortunately, there are not enough rural primary care docs. Many speculate as to why this is; however, I believe the need has resulted from misinformed med students and residents who think the lifestyle in rural America is not satisfying enough. In the July 2019 issue of South Dakota Medicine, a survey of family physicians practicing in that state found much lower burnout rates in family docs practicing in rural areas (25 percent) compared with those practicing in larger metropolitan areas (51 percent). Evidently, some social aspects of rural practice seem to confer a protective effect against burnout. This new data should be helpful when young physicians are looking for the most satisfying places to practice.
My elderly patient went home in about a week, happy with our community hospital and the care she received. Her doctor was also pleased, as he had the reward of successful care, the honor of satisfied family and the joy of truly helping someone while practicing in a rural setting.
Richard P. Holm, MD is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon.
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