We’re much further out than is rural
Logistics would make your hair curl
I don’t know the choice
But there’s burnout in voice
When I need to make a referral
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 last winter in Nome, Alaska, followed by assignments in rural Iowa. The summer and fall included a medical conference in Denver, working Urgent Care in suburban Pennsylvania, and Thanksgiving in Virginia. Just finished with 2 months in western Nebraska at the most reasonable job I’ve ever had, I am back in coastal Alaska. Any specific patient information has been included with permission.
Medicine has always been a team sport, none of us alone is smarter than all of us put together. Our profession has always relied on specialists.
You can’t drive to where I work from anywhere but here. Nonetheless, 21st century American medicine requires referral to specialist from time to time. They come here on regularly. Ears, nose, throat (ENT), for example, flies in for a week every two months and has a packed schedule. Cardiology comes four times a year.
We have a system for getting referrals down to Alaska Native Medical Center (ANMC), which starts with a simple call to a Case Manager, always a Registered Nurse (RN). All three RN nurse managers have a firm grasp of realities of Alaska life and the way inherent logistic problems color the provision of medical care. Occasionally, the problem at hand demands a close time frame, which is when I have to speak doctor to doctor.
On two occasions so far I have made such calls. The neurosurgeon spoke from or past the brink of burn out; he would not yield to any attempts at cheeriness or optimism. The cardiologist’s voice showed more resilience.
I remembered another Indian hospital, in another state, in another century. The adoloscent came in with intractable vomiting and personality change; I needed less than 5 minutes to make the diagnosis of Reye’s syndrome, a malady that disappeared when we got out the message not to give children aspirin. But we didn’t know the link then; we knew the liver turned to mush and the brain swelled and sometimes the child died, and we didn’t have much in the way of treatment.
After the first five minutes, I had to call the lab tech in, and midnight came and went while I awaited biochemical proof. Once I had the diagnosis solidly confirmed, I called the University medical center an hour away and started working my way up the hierarchical ladder. I presented the case to the student, intern, and resident. By the time I got to the chief resident at 3:00AM I could deliver the presentation in less than a minute, but my nerves had started to fray.
I could hear the chief resident’s heart break in the sigh and the pause. Clearly overworked and sleep deprived, he sounded cornered when he said, “Well, I guess you’ve got to send the patient down.”
I can look back on my own burnout and I can empathize with the other doctors, but I don’t have a solution when we cannot make enough doctors to staff the system without working most of them more than 60 hours a week.
The neurosurgeon probably works more.