Before my third year clinical rotation at Rumford Hospital in Rumford, Maine, I was unaware of how strong the physician-patient relationship could be because I ever experienced medicine practiced in a rural setting. While hospitals in large urban areas have the benefit of having a plethora of specialists for every disease imaginable they often are not able to build the strong physician-patient relationship like that of rural areas. Being able to do a clinical rotation at a rural community hospital has broadened my perspective on what opportunities are available for me after medical school and residency have ended.

Care over the lifespan

I never worked with a family practice doctor that would serve as the doctor for the entire family for every single stage of their lives. I was able to work with family practice doctors that would serve as a mother’s OB/GYN throughout their pregnancy, and at the time that they delivered the baby they would gain a new patient–the baby. They would the serve as a pediatrician and do every well-child check that the baby needed until it became a adult. At that time the physician became a adult medicine doctor and would assist and treat the patient throughout their adult life. The primary care physician (PCP) would manage everything from colposcopies to end-stage renal disease. This autonomy that the physician had, enabled their patients to fully trust them because the patients knew that they could always count on their doctor.

Furthermore, the family practice doctors did not just manage their patients on an outpatient setting but inpatient as well. They would receive a call from the emergency medicine physician saying that their patient needed to be admitted, at which time the doctor would go to the hospital and admit the patient themselves. Throughout the course of the hospitalization, the physician would round on their patient every morning and then go and see outpatient appointments all day log. While this sounds like a lot of extra effort, I believe that it builds strong connections between the physician and patient and creates a trust that bigger hospitals can rarely, if ever, establish.

Strong relationships save lives

This relationship was exemplified one day during my time there. A patient went to the emergency room and said he had been having chest pains for two weeks. The doctor in the ER notified the patient’s primary care physician who went over to evaluate him. A complete evaluation revealed high cardiac enzymes, indicative of a myocardial infarction that had occurred over a week prior to coming to the hospital. The PCP followed his enzymes with serial lab draws which all showed a decrease in number, and there was no sign of injury on EKG indicating that he was clinically better and could go home. It was further recommended by a cardiologist at a larger associated hospital that the patient was stable and did not require any further treatment as an inpatient.

However, the patient still complained of pain and the PCP was concerned because this patient apparently never complained of pain. He was the type of person to walk into her office with a broken leg and say that it was fine. She had known and treated this man for years and knew that something must be wrong for him to complain of pain, so she kept him overnight in the hospital. She followed his cardiac enzymes further and the next morning they had drastically increased in number, indicating that he was having another myocardial infarction. By still being at the hospital, he was able to begin treatment immediately as well as eventual transport to a larger hospital for full cardiac workup and heart catheterization.

At a larger hospital, this patient likely would have been discharged home before there was evidence of a second infarction taking place and I believe that the relationship that he had developed with his PCP extended his life span and perfectly illustrates the positive outcomes that are the result of smaller, rural hospitals such as the Rumford Hospital.