How to get the most out of rural medical life
Charles Helm, MD
Tumbler Ridge, BC
Tumbler Ridge is a coal-mining town (pop. 3500) in northeastern BC. It has 3
permanent family physicians.
Can J Rural Med vol 2 (4):191-92
A succession of near-burnouts and dramatic rescue/vacations is unsustainable in
the
long term for any rural doctor. Something is needed to make the "daily grind"
more
than just tolerable. Pleasure must be sought in the simple and the seemingly
mundane.
It is not exotic holidays that will determine whether you are happy with rural
life. It is
weekends and daily leisure time. Make the most of these moments and find ways to
get
far away from your pager and telephone when you are not on call.
Rather than seeking out dramatic and exciting holiday destinations, return to
your roots
and go to visit your extended family, who are likely far away. There is nothing
more
important for your children on vacation than being with their grandparents and
understanding where their parents were born and raised.
There may be a dearth of cultural activities in your community, but a good
stereo,
VCR and TV can minimize this. When a cultural event does come to town, it may
not
be the Three Tenors, but you will be there in the front row.
You need to explode the myth that a quarterly shopping siege of the big city is
a must.
North America is consumer heaven and its mail-order services are unparalleled
anywhere else in the world.
Be nice to your hospital board. Remember that it consists of volunteers with
good
intentions, who perhaps don't have the background in the health field that you
do. But
if they threaten the well-being of your patients, stand your ground in a
consistent
fashion. Make sure that they are accountable and do not make decisions in
camera.
Be fair with your hospital administrators. Make it clear that any reasonable
suggestions they come up with will receive your full support. Offer your insight
wherever possible if it will help to reduce bureaucracy. However, if
administrators
mistake their priorities and cannot understand the needs of patients through the
morass
of budget constraints, spare nothing to expose this.
Get a good computer. With it you are not nearly as isolated as your predecessors
were
even a few years ago. Get on the Internet and participate in teleconferences.
Appreciate your office staff and be grateful that neither you nor they are
unionized;
your office will be a shining example of efficiency and the work ethic. Take
delight in
helping a genuinely ill patient after closing time, without watching the clock
and
demanding overtime pay.
Make sure your office has a massive picture window from which you can admire the
mountains or the sunset. Because you may spend over 2000 hours a year in your
office, it must be as happy and relaxed a place as possible.
Learn from your patients, and enjoy them. By virtue of sharing a remote location
with
you, most of them will be interesting folk, the salt of the earth; they can
imbue you
with wisdom and regale you with interesting tales. Strive never to become
indifferent
to their suffering, misfortune or pain.
Your patients' health is important, but your own health is just as important.
Because
you live in a rural setting in Canada you have access to unlimited clean air,
with
hiking, running and cross-country skiing opportunities that your urban
colleagues have
to travel hours to reach. Your physical fitness will not only be an example to
your
patients, but you will treat them better when you feel better yourself.
Pursue your hobbies with passion, make sure your family can share them, and
don't
underestimate their significance. Even though you may consider yourself average
in
your field of interest, chances are that in your region you are an expert and
will be
able to contribute something valuable. For example, an amateur ornithologist may
find
that no one had ever before noted bird sightings in such a remote area and that
the
provincial database desperately needs these records.
Get involved in your community; your education and skills will be of great value
in a
small town. The projects you succeed in seeing through to completion will be
surprisingly satisfying and significant. But set limits on the amount of time
you devote
to these activities; your family is more important.
Your summers will be incredibly wonderful. You will be able to finish a full
day's
work at the office and still have 6 hours left in which to hike to a swimming
hole
beneath a waterfall or canoe your favourite stretch of river. Push yourself hard
these
months to allow you and your family to enjoy the beauty of the wild unpopulated
world around you.
Your winters will be long. Do not fight them. Fleeing to warmer climes leads to
misery on your inevitable return. Make the snow your ally, not your enemy. Build
a
quinzhee* in your back yard, eat your meals there and study there; it will be
the
quietest place around. Ski to work. Ski every day. Take a 2-hour lunch break
throughout winter, in which to ski and absorb sunlight. Find a cabin with a nice
warm
stove, where you can ski to after work with your family. Enjoy the solace of the
silent
winter woods. Your concrete-bound urban friends have no concept of the magic of
these days or the quality of your rustic lifestyle.
Make a point of complaining loudly and bitterly in winter when the mercury
creeps
above the freezing mark and your carefully manicured ski trails become icy. When
the
roads get bad in winter, challenge yourself to count how many consecutive days
you
can thrive in your simple contented existence without the desire to be someplace
bigger.
Above all, believe in yourself. It may seem at times that you are unappreciated,
but
steer a straight course, secure in the knowledge that you are doing a vital job
that
scares the daylights out of many urban physicians, one that no one else can
offer as
cost-effectively. Remind yourself that you can make a difference in the lives of
your
patients.
You are on the front line of medical care. Revel in this excitement, and regard
the skill
of stabilizing and transferring the critically ill or injured as a challenge.
You are their
bastion against death and disability, so make sure you are proficient in your
life-support skills.
Remind yourself that the chances of a successful malpractice suit are directly
proportional to the amount of specialized backup available. If you are prepared
and
do your best, there is little to worry about.
Thrive on your generalism. Any conceivable problem could confront you at any
minute; you know enough of everything to get you by. Don't let anyone devalue
this
skill.
If you work reasonably hard, your income will support your whole family. You are
thus in the privileged position where your spouse may choose to stay at home
with the
kids in their formative years. If so, value this work highly and praise it
incessantly.
Without your spouse's support, you are a lesser being. Nurture this relationship
and
never neglect it.
As long as you are there for them, your kids will grow up with a fine education
that
will include a fishing hole around the corner, a treehouse in the backyard and
ski trails
that start at their doorstep. Because you live so close to your office, you will
be able
to spend hours more with your kids each day. Remember that good parenting is
more
important than fancy schools.
The saddest patient I can think of is the one who said to me once: "This is such
a
terrible place, I am so bored here; all you can do here is work, enjoy nature
and be
with your family." As your patients' confidante, you must remain inscrutable and
empathetic. So never let them realize that the statement that irritates you more
than any
other is: "I just can't wait to get out of this town!"
*Native Canadian word: a snow house or igloo-like shelter, made out of a huge
mound of snow, left to settle and then dug into