JUNE 30, 2006


'See one, do one, teach one': a rural education

Tuesday As many of us in practice know, the day after a long weekend is usually chaotic. This week our hospital also takes a number of first year medical students as part of their educational exposure to rural medicine. We're getting more involved in teaching as medical schools scramble to train their increasing numbers of students. We rural physicians hope that, over time, it will eventually help alleviate doctor shortages in our neck of the woods. This is all very grand and altruistic, but today I have a morning clinic that's bursting at the seams.

When things are a bit calmer later on, I take one of the students to the nursing home where we visit a number of patients and see a variety of medical problems. He has visited a home only once before. He's both interested and enthusiastic and has a naturally kind demeanour that my patients take to — even the demented ones! I have a number of patients with basal cell cancers and actinic keratoses and I quickly get him involved in treating them with cryotherapy. The old adage of "See one, do one, teach one" kicks in and before long he's an expert. Later that day he helps me pick out a guitar for my son's birthday.

Wednesday I get to the hospital early to remove a lesion from a patient's forehead that has all the hallmarks of a basal cell cancer and the same student scrubs in to help. If this keeps up I'm sure he'll soon think rural life is bad for the skin. After seeing my inpatients I attend rounds. This includes a session with a medical ethicist, something I was not looking forward to. Most of these people seem to relish 'muddying the waters,' but this person was bright, dynamic and, for an ethicist, decisive. He brought with him several scenarios that acted as a springboard for discussion. When things ended I felt a bit more comfortable dealing with some of the more controversial issues we face regularly in medicine.

That afternoon a different student joins my colleague and me for our clinic. His interests are more internal medicine focused. When I was in first year I had no idea what some specialities did, let alone which I wanted to pursue.

We find a few patients with an IM-sized list of diagnoses. However in mid clinic a patient comes in with an inflamed cyst that needs draining. We freeze it, do a cruciate incision over the most fluctuant area, and drain a large amount of rancid material. I get the student in there probing and pushing out the contents. The patient is cooperative and pleased at the relief he gets. The student appears to enjoy it too. The enthusiasm of first years is good for the soul. That night we attend a medical talk on lipids and small dense LDL particles. Even this fails to dampen their enthusiasm.

Thursday A new student this morning in clinic, this time interested in hearing chests that have different clinical findings. As luck would have it, the chest sounds are monotonously normal and we're stuck seeing crying kids and the demented elderly. At last a diabetic smoker with heart disease comes in with a six-day history of productive cough and malaise. Alas her chest is also clear.

That afternoon I and a colleague convince two of the students to join us in a round of golf, something we try to do every Thursday in golfing season. These two feel they're playing hookey but we rationalize that they need to get a taste of life in the country. The golf is predictably unpredictable and a winner is not decided until the last putt.

Friday Clinic goes fairly smoothly through the morning. I get our student to see an 18-year-old squeezed in for a rash after a desperate phone call from his mother. After his history and exam I come in to critically appraise the student's history, exam, diagnosis and treatment. Our derm emergency turns out to be a two-year case of acne affecting the upper trunk, face and neck. His mother, it turns out, is a dermatologist.

That afternoon our students head back to the city and their summer work. While their presence slows the pace, it keeps life interesting and more than makes up for any loss of time or income.



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