A Country Doctor Writes:

I volunteered to work Saturdays. And to do walk-ins. And to take all comers, not just our patients.

It has been an interesting journey.

Some clinics put their newest, least experienced clinicians on the very front line of doing urgent care. Here, it’s the opposite. I’ve got 39 years under my belt and I see everything from sore throats to people who left the emergency room in the middle of a workup because their anxiety kept them from waiting for their CT scan to rule out a blood clot in their lungs.

The waiting room fills up, and it’s just me and a medical assistant.

It’s refreshing and rewarding to see things that can be fixed in a matter of minutes: embedded ticks, corneal foreign bodies, pieces of hearing aids deep inside ear canals, bursitis cases and nursemaid’s elbows.

My very first paychecks as a doctor came from weekend stints back in Sweden while I was still in medical school. At least back then, they had a system where senior medical students could be given temporary privileges as locum tenens physicians with minimal supervision. I worked weekends, Friday night to Monday morning, seeing patients that weren’t sick enough to need the full resources of the emergency room in a hospital about an hour away from my medical school.

Already then, I thrived on not knowing what challenge was next up. Whatever it is, I’ll do my best, I figured. And at that point, the resources of the emergency room were right down the hall.

Here, the emergency room is 20 miles away, but the ambulance is only a couple of miles away and I’m not the stand-in EMT the way it was when I first came here.

Primary Care is turning into a specialty of chronic care and public health. Some of the chronic care we do is really what internal medicine specialists used to do before they all wanted to subspecialize or go into hospital medicine. And much of the acute care we trained for is now being done by emergency and urgent care physicians as well as PAs and Nurse Practitioners.

And Public Health is a very different thing from what doctors of my generation trained for. I still feel it is better suited for nurses than doctors. I didn’t attend medical school for 5 1/2 years and do two residencies just to blindly follow rules; I trained to know when rules and guidelines do and don’t apply.

Doctors are trained to identify the exceptions from the rule, which is a useful skill on the front lines. Which migraine is really a brain tumor? Which asthma attack is a foreign body in the trachea? Which rash is a sign of leukemia?

I worked hard today, but I don’t feel drained; I feel energized, because I cured a few people, and closed a few cases. Chronic care with no acutes wears on you. The extra work I do may seem like a burden to some, but I find it rejuvenating. It brings a healthy balance to my work week.