Best Quotes in RME

"Physicians occupy an unusual spot in the social structure of rural communities. From an economic standpoint, they are successful entrepreneurs, well-paid business people similar to bankers and lawyers. On the other hand, they are also social servants like policemen or teachers, just as essential to the welfare and functioning of the community but paid for through a fee-for-service mechanism outside of local community control. This anomalous status requires some fairly innovative interpersonal and structural relationships to strike a workable balance." Rosenblatt and Moscovice, 1982   Rosenblatt     Moscovice

Building a community-responsive rural practice is endless work, a job that inevitably becomes as frustrating as it is rewarding. It requires a large tolerance for uncertainty and willingness to risk. One must deal effectively and tactfully with a variety of constituencies, any one of which can enhance or threaten the success of the venture. These include community people - supporters and opponents - local physicians, government officials, a hospital, one or more funding sources, a new staff and, of course, patients and their families. Not everyone is enthusiastic for the new practice or empathetic with its leaders- who are at all times expected to maintain their own idealism, energy, and optimism. New rural health centers are fragile entities, both economically and politically. When they finally succeed in becoming established it is usually because their people-leaders, staff, board members-were as stubbornly determined as they were resourceful.    Donald L. Madison, 1980   Madison

If you want physicians to go to location where they need to do more caring and service than usual, you have to pick students who want to do more service and caring than usual - RCB 2001   Service Orientation

Compare these two quotes a century apart:

• Medical education is not just a program for building knowledge and skills in its recipients... it is also an experience which creates attitudes and expectations. Abraham Flexner 1914  
• ".....Medicine continues to foster an aura of infallibility of the physician, and in many ways remains a "blame-and-shame" type of profession, in which the individual physician is supposed to know everything and not acknowledge when he or she is wrong or makes errors. Problem solving should be the 21st-century paradigm for the profession. Although the acquisition of new knowledge will remain important for the profession, it is the use of knowledge to produce change that should be a central feature of the knowledge effort in the 21st century. .........." Kenneth I. Shine, M.D. President of the Institute of Medicine, National Academy of Science
• "The belief that disease can be conquered thru only the use of drugs deserves special attention. It's fallacy is that it fails to take into account the difficulties arising on the ecological complexity of human problems." Rene Dubois  To add to our collection. from Lawrence Silverberg

Could we choose students that can problem solve and pick up knowledge for the sake of change instead of other agendas. Wouldn't these choices be best for the nation, not just the underserved parts? - RCB

How about history repeating itself: "The medical schools of our country need to take a closer look at the format of medical education that was promulgated following the Flexner report over 7 decades ago. Recent reports have focused on the impact of the malpractice insurance crisis on family physicians in New York State. Physicians nationwide, out of economic necessity, have reluctantly refused to accept new Medicaid patients. Trust between patient and physician is diminishing, and physicians are limiting their practices, ordering more diagnostic tests, and consulting more frequently. The attrition of family physicians from death, retirement, disability, and dissatisfaction with unfavorable malpractice insurance costs and the current legal climate is extremely serious." Verby JE, Baird MA, Wolff T, Beatty PG  New York Initiative

Time to wake up and discover what many have found to be true in years past:

"In one year the (RPAP) student develops surprising professional maturity. In the classroom of real life he has learned tha sound medical practice is born of sound medical theory. He has seen how rural family practice can bend or break a man but how it rarely bores him. He has witnessed the challenging clinical mix of the mundane and the monstrous. And he returns to academia a wiser, more confident, more searching student." JK Heid 1979 RPAP Boon to Rural MN

"RPAP builds bridges of good will between the University and rural doctors. Many physicians recall the days when the hapless and hopeless referring LMD was dismissed with scorn at the professor's grand rounds. Times have changed! Monthly University visits have done much to dispel the doubts. When men of professional stature… come out to the rural hospital, make rounds, break bread, and discuss common problems with the local medical staff, new bonds of understanding grow quickly between small town and gown." JK Heid 1979 RPAP Boon to Rural MN

"The rural physician today is something of a breed apart. He thinks he owns the best of both worlds. He lives and works in a rustic, often pastoral, setting. Still, with the ease of modern transportation, he finds that the cultural and recreational attractions of the city lie within his easy reach. Granted, it was not always so. The beloved horse and buggy doctor of the past suffered professional isolation and grueling demands on his time. False image die hard. RPAP places the student in the country to find out for himself." JK Heid 1979 RPAP Boon to Rural MN

"Does RPAP motivate the student to later return to the rural area as a fully training doctor? This, of course, is the ultimate test of the success of the program… (stats presented) … In our case, our first RPAP student returned to join us in practice (as have 60 of 900 so far - ed note). And it may signal the wave of the future to note that this young physician, an honor student, chose primary care rather than academic medicine or research. RPAP could just become the best doctor recruitment program that the rural areas have known." JK Heid 1979  RPAP Boon to Rural MN

Health professionals education represents one of the South's major successes….. despite increases in the overall supply ….. serious problems of distribution of professionals to geographic, subspecialty, and public service areas of need continue, except for those situations in which carefully coordinated strategies have been directed to specific problems Southern Regional Education Board 1983

Some practitioners come mature, some mature without you, some need assistance, and some never grow up. - RCB

Selecting for the most intellectual individuals is not a good thing for rural communities, and perhaps not as good for the nation's health care.... There are countless communities who have sacrificed much effort to ensure a functioning rural health system who have suffered because medical education does not select and train physicians who can locate in rural communities. - RCB   Selection vs Socialization

"If an admission committee informs itself of "what finally happens" to those it admits, its decisions can contribute to achieving whatever policy its medical school adopts with respect to the mix of physicians it wishes to produce." Don Madison

Osler and Rural Practice

Wisdom and Humor from Various Sources

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