Welcome to Elma–21st century changes in rural practice

–Mitchel Cohen

Hey, you must be our medical student for the day. Short white coat gave it away.
Did you find the office OK? Good, directions aren’t too difficult. There’s only one light in town and I always tell people if you just look for the funeral home and the liquor store we’re just past that. People often drive right past the building though. Most think it is just a one-floor rambler style house. They really have no idea of the history of what’s happened here.

Come down the hall this way; let me show you this picture. This is a drawing
of this office back when it was a hospital. It was built in 1898 by Dr. Blair. There
were two beds for men, two for women, and a surgery/storage area. The nurses
lived in a house attached at this end. Did I mention there was no running water or electricity when he opened his hospital? He put that in ten or twenty years later.

Here’s the mini-library we’ve built and a computer that you’re free to use. We’re still fairly technologically challenged out here. Our IT department consists of whatever we can figure out or con friends and family into helping us with.

Information technology is certainly one of the biggest challenges of being in a small, rural practice. There’s so much potential yet so many barriers. Purchasing, implementing, and maintaining an electronic health record is an expensive proposition. Telemedicine could help bring specialists in for virtual office visits, but again, who can afford to set that up? There’s admittedly some element of technophobia in here. Much of our staff, as wonderful as they are, still are not comfortable with some basic computer functions. There’s a certain conservatism that comes with small-town life, and while this is often a good thing, technophobia is probably not good.

Dr. Cohen addresses the tremendous changes that have occurred in medicine in the last century. As a child of the computer age, you may not fully appreciate the shift the electronic health record brings to patient care, especially for physicians who thought typing was for their secretaries and not for them. The organization of health care into health systems and coops brings resources and economies of scale so that adopting telemedicine and the electronic health record might be a little easier. With that physicians lose some autonomy. The productivity treadmill, which is part of medicine today, removes some of the “fun.”  You may rotate with physicians who have adapted well to the IT age of medicine and others who are moving like dinosaurs.

Dr. Kurt Stange and colleagues have spent a lot of time thinking about how practices adapt and keep up with the rapid changes in medicine today. This 2008 on-line article in the Journal of Family Practice: A survivor’s guide for primary care physicians, examines what works and doesn’t work about practice change. ARTICLE Give it a read, see what you’ve noticed in the setting where you’ve been spending time.


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