I recently spent a month at the Swift River Rural Training Track residency program in Rumford, Maine working at one of two outpatient family medicine clinics, seeing patients admitted to the small critical access hospital, and learning more about what rural medicine has to offer.

Creating a sense of family
The most influential aspects of this experience were the extreme sense of community and pride the physicians and staff had for their work and the patients, and the welcoming attitude they showed during my stay. Because of the small size of the town and surrounding areas, the medicine practiced here was “true” family medicine, with several, if not all, members of the same family seeing the same physician for their medical care. This created a great sense of family between the provider and the patient.

It was not uncommon for a mother to bring one child to the doctor for a well-child check, and during the same visit pick up a refill for her personal medication, as well as have another child seen for new symptoms of an upper respiratory infection. Having the continuity with patients and their extended family helped the physicians I was working with to better understand the social situation the patient was dealing with outside of the office. Knowing what the patients’ home lives were like helped us to better formulate a treatment plan that would be reasonable for the patient to follow through with.

There was one patient that I saw that highlighted the lack of local resources for some patients in such a rural location. We saw a young woman who was pregnant, but also suffering from addiction to opiates including IV drugs during her pregnancy. She was motivated to do what was in the best interest of her baby, but there were no local suboxone-prescribing providers available that would accept new patients. The closest clinic where the patient could receive the medication she needed was over an hour away, and the patient did not have the financial resources for transportation there. Up until the point when we saw her in the office, she had been forced to buy this drug off the streets. Together, we tried to find resources that would be able to help with transportation costs associated with traveling to receive the care she needed. This would not have been as much of a struggle and a logistical nightmare, had we been located in a large, urban area.

Full spectrum care with a lot of variety
Despite difficulties in linking patients to social resources that are convenient and practical for effective treatment, I was able to see true full spectrum family medicine. Over the month, I was able to assist with a circumcision, perform morning rounds on several patients admitted to the hospital; see numerous pediatric patients in the office for acute visits and adult patients following-up for their chronic medical illnesses; scrub-in on an emergency Cesarean section; perform sports physicals for adolescents; see post-partum and newborn patients; and perform in-office procedures, such as IUD insertions.

The variety between patients seen in the same day was remarkable, more so than I have experienced in other rotations. One experience in particular showed the true rural nature of the practice. A man in his mid-50s began to feel ill at home, with nausea, diaphoresis, near-syncope, and chest pain. Living only a few houses away from the clinic, he drove himself to the clinic and told the front desk staff the symptoms he was feeling. Concerned the patient was experiencing a heart attack, we saw him immediately and recommended he be evaluated further in the emergency department and be transported by ambulance. He was concerned about leaving his truck in the parking lot overnight, so the physician offered to drop it off in his driveway at the end of the workday.

Even though this unexpected urgent appointment made the rest of the afternoon a catch-up game of trying to keep patients from waiting too long, it was very rewarding to be able to help this gentleman in a setting where he felt comfortable. The close relationship between the patients and the physicians is a great testament to the quality of care provided in a rural area.