by Jillian Hess, MD
I recently completed my 1-month rural rotation in Kanab, Utah. As a person who has roots in rural Wisconsin, I was really looking forward to this rotation to explore what it’s like to practice in a rural setting.
I was assigned to work with an attending who is one of four family medicine physicians who run the whole clinic/hospital/ER in this small town of Kanab. Between the four of them, they take turns doing 24-hour shifts covering the inpatient hospital and the ER, with other weekdays being spent in the clinic with their patients. They all provide OB care as well and go to the hospital for deliveries when their patients are in labor. Some of the attendings also do colonoscopies one day per week.
A day in the life went something like this:
- 7:00 am: Sign out for ED patients and admitted patients to the next physician on call (the previous 24 hours were spent covering the hospital and the ED)
- 8:00 am: Colonoscopy #1 – 40-year-old female with GI symptoms
- 9:00 am: Colonoscopy #2 – 75-year-old female with family history of colon cancer and colon polyps
- 11:00 am: Walk over to the clinic: 24-year-old G3P2 at 25 weeks gestation for OB return visit
- *with a quick walk over to the hospital radiology department to show the family her baby by ultrasound* (whose family I had seen in clinic in previous weeks and had waved at me several times in the neighborhood
- 11:15 am: 85-year-old female hospital follow up for heart failure exacerbation
- 11:30 am: 2-day old female newborn exam
- 12:00 pm: Lunch
- 1:00 pm: 32-year-old female with urinary symptoms
- 1:30 pm: 55-year-old male with chronic back pain, hypertension *(congratulated my attending on the recent marriage of his daughter)*
- 1:45 pm, 2:00: 3-year-old male and 5-year-old male well-child check from the same family
- 2:30 pm: 60-year-old male for type 2 diabetes follow up *(asked if I had a dog, he had seen me walking him in the neighborhood)*
- 2:45 pm: 25-year-old female with concern of infertility
- 3:00 pm: 83-year-old female with poor wound healing after a fall and laceration
- 3:15 pm: 45-year-old female with lump on wrist, aspirated a ganglion cyst *(also congratulated my attending on the recent marriage of his daughter)*
- 3:30 pm: 38-year-old male with sleep difficulties, found to have severe depression and suicidal ideation
- 4:00 pm: 11-year-old female with ear pain *(discussed her summer experience with the swim team and her upcoming fall sports)*
- 4:30 pm: 58-year-old female with hip pain, gave steroid injection for trochanteric bursitis
The breadth of practice ensures that work will always be interesting and challenging; it seems that this is a common reason that people ultimately choose a career in family medicine, but this is even more true in a rural setting. The above schedule is an example of this, but it is also a good example of how important rural family doctors’ skills are to the community. These are patients who are diverse in personal background, age, and clinical concerns, but are all patients who need care and have direct access only to the family doctors present in their area.
One of the most special things about rural medicine is the connection to community and having the benefit of truly knowing your patients in the larger context of their lives. My attending knew his patients and his patients knew him; and even in my short time in the community, patients were interested in learning more about me. It’s a good reminder that our patients are much more than their diagnoses, and knowing that can ultimately help provide them with the best care.
Dr. Hess is from Bear Valley, Wisconsin. She completed her undergraduate degree at the University of Wisconsin Madison and her medical degree at the University of Wisconsin School of Medicine and Public Health. Her medical interests include rural family medicine, lifestyle medicine, and geriatrics. In her time outside of the hospital, she enjoys weightlifting, hiking, and spoiling her rescue dog, Bruce, and her senior cat, Edna. She was impressed by the University of Utah’s warm and welcoming faculty and residents, the balance of community and academic training sites, and the endless opportunities to explore beautiful Utah.