Family Medicine Vital Signs

By Matt Evans

Greetings, audience.  I’m Matt Evans and I’m a third year family medicine resident here at the University of Utah.  In addition to my standard third year resident responsibilities and my professional ADHD that results in me taking on more projects than a reasonable person would, I moonlight down in Kanab, UT one or two weekends per month.  In Kanab, I cover the emergency department (ED) and also admit patients to our 10 room mini-hospital when they are sick enough to need inpatient care.  I also transfer many of the critically ill patients who present to our ED to the nearby tertiary medical center that is approximately 30 minutes away by helicopter.  I cover obstetrical emergencies, assist the local providers with emergency cesarean-sections when needed, and manage pediatric sepsis when sick pediatric patients present.  I have given thrombolysis to a patient with an acute heart attack (STEMI), I have given tissue plasminogen activator (tPA) to an acute stroke patient, and I have reduced a comminuted ankle fracture and replaced an artificial hip dislocation all in the same weekend down in Kanab.  How is a family physician who is nearing completion of his training able to do all of this?

Because of technology.

Technology really is why I’m able to be a full spectrum family physician while I’m still in training.  When the acute stroke patient walked in the door, I performed an NIHSS (stroke scale) to determine that her stroke was severe enough for tPA but not so severe that was excluded from being a candidate for the clot-busting drug.  When a STEMI patient walked through the door, I took a cell phone picture of the patient’s EKG and texted it to the interventional cardiologist at the nearby tertiary medical facility.  He agreed giving thrombolysis was the right decision, and we gave this clot-busting/life saving/function sparing drug to a patient who had a 100% occlusion of his LAD (left anterior descending artery, AKA “the widow maker”).  When a patient had a comminuted ankle fracture and his toes were turning purple, I called the orthopedic surgeon that I have saved to my cell phone list of favorite contacts and he walked me through what I could do to reduce the fracture and  we restored blood flow to his digits.  Of course, he first requested that the X-ray of the patient’s ankle be picture messaged to him first.

I see future advances in technology leading to improved access of patients living in rural America.  I will not be practicing at a rural site next year because it isn’t what will work for my family.  I have a wife and 2 kids, the oldest of which will be starting pre-K within the next year.  It’s becoming more and more difficult to recruit providers like me who were raised in large cities to practice in small towns due to a variety of reasons.  However, I feel like technological advances will allow providers like me to donate my time to rural locations more easily in the future.  For example, once cars are able to drive themselves, perhaps I can continue to spend one weekend per month driving to a rural site from the medium sized city I plan on living in next year.  Perhaps continuing to cover ED call and hospital admissions at a rural hospital remains in my future, should technology allow it.  I can imagine my smart car driving me to a rural location all night while I sleep, and then I could complete a 48 hour shift to give the overworked rural providers a break.  Then, when my shift ends I can have my smart car drive me home while I sleep through Sunday night, leaving me refreshed for my clinical duties on Monday morning.  Rural sites desperately need the support of providers who can contribute their time to keep their small hospitals, clinics, and other medical establishments running, and I would be more than happy to do so in the future.

As technology continues to change, I’m sure rural medicine will also continue to change.  I’m sure that technological advances will allow patients better access, allow providers to make more appropriate medical decisions, and assist nearby specialists in making a difference in the lives of those that need specialty care.  So although technology may be causing humans to feel disconnected to those we care about most (seriously, put your smart phone away for a few minutes and go outside today), I’m excited for the future of rural family medicine thanks to evolving technologies.

Matt Evans, MD is a third year Family Medicine Resident with the University of Utah School of Medicine.