First Day in Western Nebraska


I started the day with some snow

It makes the cars slide when they go

And sometimes they crash

Turning Fords into trash

Even if they go really slow.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. The summer and fall included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, a medical conference in Denver, working Urgent Care in suburban Pennsylvania, and Thanksgiving in Virginia.  Right now I’m in western Nebraska.  Any patient information has been included with permission.

My first day at a new assignment in western Nebraska started in a snow storm.

Without critical access hospitals, we would not have medical care in most of 21st century rural US.  These institutions have fewer than 25 acute care beds, provide 24/7 emergency care, and are at least 35 miles away from another hospital.  They get Federal funding and they face an enormous regulatory burden.

This particular hospital houses a clinic as well as a rehabilitation facility.

I walked into a beautiful new building while fat, wet snowflakes fell outside.  I greeted nurses, doctors, medical assistants and administrators.  We commiserated on the maldistribution of doctors in this country.

They gave me a digital dictation machine for my clinic work; the Electronic Medical Record (EMR) vendor apparently takes months to get a new account going.

I shadowed one of the permanent docs before 9:00, and he watched me while I entered data into the EMR (not the same as the one used for the clinic).  Our discussion of his patient caused me to remember a tragic case (at another facility, during a different century) of a woman who died of cervical cancer rather than terminate her pregnancy.

Sitting at the computers we talked with the ER doc.  Moments after I asked that he call me if he gets a major trauma in, the radio announced a motor vehicle crash would send multiple patients to the ER.

I didn’t get permission to talk about any of the patients, but I can talk about general principles.  Snowy roads make for dangerous driving.  Take the ditch rather than have a head-on collision.  Accidents rarely happen at a convenient time for anyone.  Seat belts in general and child restraints specifically save lives.   Dysfunction runs in families.  People who take narcotics shouldn’t drive cars.

I asked the clinic manager to open my schedule up for the afternoon.  I lunched with Bethany, and returned to the clinic, where I saw one patient.

I thought the visit a smashing success.  After reviewing a complicated record, I dove through layers of history, asked a key question, and established rapport.  A surprise finding during the examination led to my ordering a sophisticated imaging test, but I won’t have results this week.  I made 8 recommendations, and the patient agreed to 6.  And, 80% of the time, patient recovery depends more on patient action than on my prescription.

 

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