Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Rural medicine reminds physicians of their value

Edwin Leap, MD
Physician
January 10, 2014
Share
Tweet
Share

Recently, while on a locums assignment in a very small, rural hospital, I cared for a gentleman with chest pain.  His discomfort seemed classic for an MI, but his EKG did not. So I treated him as normal with aspirin and nitrates, and waited for his cardiac markers to come back from the lab.  In the interim, his chest pain worsened.  Sure enough, he developed an anterior MI.  The tombstones of tombstones, you might say.

Well, this wonderful facility did not have a cardiologist on staff, much less a cardiac cath lab.  So, I went “old-school.”  I gave him a thrombolytic.  I know, seems pretty Stone Age, doesn’t it? But it was the right thing to do.  There was no interventional cardiologist in the area; in fact, the patient would ultimately be transferred by fixed-wing aircraft to the nearest cardiac care center.

While he had one brief episode of ventricular fibrillation (responsive to one shock), his event was otherwise unremarkable and his EKG normalized before the flight crew ever arrived.  He was pain free and grateful as he was loaded for his trip to the referral center.

Afterward, two things became evident. First of all, the charge nurse thanked me for making a decision quickly. Apparently, she had experienced some locums physicians who were uncomfortable simply making the call on their own. They inevitably wanted to show their patient’s EKG’s to cardiologists and have discussions.  I looked and acted.  Second of all, I realized yet again how much fun it is to be … important!

We live in an era of specialists and subspecialists and sub-sub-specialists.  In large cities, the job of the emergency physician is to order the EKG as quickly as possible (hopefully before the patient arrives it seems), and call the right interventional specialist in something like a nano-second.  In some places, we serve as facilitators, almost brokers.  But in the small centers of America, where the advanced technology of medicine isn’t always immediately available, our job becomes absolutely critical.

I find that refreshing. And exhilarating!  Too many young emergency physicians have grown up in the long shadows of never-ending back-up. But a few short miles out of the city, an airplane flight over a mountain, a drive along a jagged coast and one may discover that he or she, as an emergency physician, is the truly the last, best hope for patients who populate the remote parts of America, doing hard work in hard industries.  We are needed by farmers and timber-workers, miners and fisherman, hunting guides and raft guides, truck drivers and oil-well workers and all their precious loved ones.

I encourage physicians to reach out and work in the remote places.  Take the chance and take your skills out to the places where they are truly precious.  If you are older, your experience will be priceless.  And if you are younger, well be bold and do your best.  And learn to make decisions ‘all by your lonesome.’

You may find that working in those out of the way places is just the thing you need to remember how very special, and very valuable, your skills and experience really are. And why worry?  Help is only a fixed-wing flight away.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test. This article originally appeared in The Barton Blog.

Prev

The intense world paradigm for understanding autism

January 10, 2014 Kevin 3
…
Next

3 health care predictions for the New Year patients should know

January 10, 2014 Kevin 8
…

Tagged as: Cardiology, Emergency Medicine

Post navigation

< Previous Post
The intense world paradigm for understanding autism
Next Post >
3 health care predictions for the New Year patients should know

ADVERTISEMENT

More by Edwin Leap, MD

  • The emergency department crisis: Why patient boarding is dangerous

    Edwin Leap, MD
  • Hospitals at a breaking point: Lack of staff and resources leave ERs in chaos

    Edwin Leap, MD
  • Trapped in a cauldron of suffering, medical staff are weary

    Edwin Leap, MD

More in Physician

  • The truth about perfection and identity in health care

    Ryan Nadelson, MD
  • Civil discourse as a leadership competency: the case for curiosity in medicine

    All Levels Leadership
  • When a medical office sublease turns into a legal nightmare

    Ralph Messo, DO
  • Why the heart of medicine is more than science

    Ryan Nadelson, MD
  • How Ukrainian doctors kept diabetes care alive during the war

    Dr. Daryna Bahriy
  • How women physicians can go from burnout to thriving

    Diane W. Shannon, MD, MPH
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • The truth about perfection and identity in health care

      Ryan Nadelson, MD | Physician
    • Civil discourse as a leadership competency: the case for curiosity in medicine

      All Levels Leadership | Physician
    • Healing beyond the surface: Why proper chronic wound care matters

      Alvin May, MD | Conditions
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Dear July intern: It’s normal to feel clueless—here’s what matters

      Tomi Mitchell, MD | Education
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • The truth about perfection and identity in health care

      Ryan Nadelson, MD | Physician
    • Civil discourse as a leadership competency: the case for curiosity in medicine

      All Levels Leadership | Physician
    • Healing beyond the surface: Why proper chronic wound care matters

      Alvin May, MD | Conditions
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Dear July intern: It’s normal to feel clueless—here’s what matters

      Tomi Mitchell, MD | Education
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Rural medicine reminds physicians of their value
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...