Posts Tagged ‘rural medicine’
By Juleah Williams
Among this season’s new fall line-up comes a new drama from the CW – Hart of Dixie – featuring surgeon-turned-country doctor Zoe Hart. Full disclosure: As can be expected from most CW programming, this show is geared toward a teenage audience and includes enough love triangles and “frenemies” to keep their attention. However, exposing this young population to the benefits of primary care and emphasizing the importance of having a relationship with a personal family physician is crucial to increasing interest in the specialty down the road.
As the story goes, Zoe graduated at the top of her class from medical school and seeks to follow in the footsteps of her father, a cardiothoracic surgeon. After residency she fails to be accepted into a fellowship because her superiors deem her “too cold.” Desperate, she decides to accept the offer of a kind stranger—who turns out to be her real father—to join his family medicine practice as a general practitioner in Bluebell, Ala.
Zoe moves from New York to Alabama to find that her real father has passed away and left her half of the family medicine practice. His former partner, Dr. Brick Breeland, resents the young hotshot doctor’s presence.
As a side note, while it’s technically correct that she can enter practice as a “general practitioner” without completing a residency, they refer to her later in the episode as a family doctor. Her patient population may include entire families, but she didn’t complete her three year residency in family medicine – and this is a little misleading for viewers.
Technicalities aside, the show’s characters find themselves in mostly-realistic, but dramatized medical emergencies that you might expect in a rural setting. And it’s in these moments that family medicine really shines. In the most recent episode, Zoe is nearby when a farmer’s arm is trapped under a piece of heavy equipment. Moving the machinery will cause him to bleed to death, so she must perform an arterial clamp in the field. However, she must call her indignant practice partner Brick for assistance because…wait for it…she was bitten by a snake earlier in the episode and only has one usable hand.
When he arrives, Brick doesn’t know how to perform the procedure and he refuses to let her talk him through it; he doesn’t want to be “her puppet.” Of course he relents for the good of the patient and together they save the farmer’s arm and life. As word spreads through the town, Brick receives all of the credit and Zoe (who has been trying her hardest to fit in) gets jealous.
This is the big moment: Zoe confronts Brick, saying that he couldn’t have performed the procedure without her. He replies with the fact that after the patient was out of danger, she left. He calmed the panicked patient, rode with him to the hospital in the ambulance, spoke to his wife and reassured her that their livelihood would be okay – all part of his comprehensive care after the initial encounter. This is the “ah-ha” moment of the show as Zoe recognizes that she has a lot to learn about being a primary care doctor.
So for now, the show portrays family physicians as the quintessential doctors – able to care for medical needs while adding an extra element of having a strong relationship with patients and a deep understanding of the community. That’s spot on. As the season continues, I’m intrigued about how the show will ultimately portray the small town family physician.
Juleah Williams is TAFP’s Student, Resident, New Physician, and Membership Coordinator.
As a die-hard fan of the Texas Longhorns, I have no shame in telling you that after last year’s 5-7 record, I was glad the college football season was over. Even though I’m a self-admitted policy wonk and political news junkie, I was equally relieved—even somewhat jubilant—when the 82nd Texas Legislature finally closed up shop and went home. If you followed the frustrating struggle to balance the state budget without additional revenue, and witnessed the resulting cuts to higher education, public education, and health and human services, you might have been just as ready for it to end as I was. At least when they’re not in session, they can’t do any more damage, right? Now is not the time to bury our heads in the sand. In fact, the legislative interim is perhaps our best opportunity to formulate and articulate our most effective arguments for renewed investment in Texas’ primary care infrastructure. We can document the ill effects of the drastic reduction in state support for graduate medical education, especially in family medicine residency training, and we can illustrate the broken promise of access to primary care physicians for underserved communities made manifest by the 76-percent cut to the state’s Physician Education Loan Repayment Program.
And now is the time to begin preparations for a major initiative in the next legislative session. In the late ’80s, rural medicine in Texas was in terrible need of state investment. Health care organizations and advocates rallied around a broad set of goals encompassed in what was called the Omnibus Rural Healthcare Rescue Act, which the Legislature passed in 1989. The law created the Center for Rural Health Initiatives and the Office of Rural Health Care, and it contained tort reforms, benefits for rural hospitals, several reforms to strengthen the state’s trauma care infrastructure, and new recruitment and training programs for primary care physicians. Family medicine won funding for third-year clerkships, among other valuable reforms.
As our state demographics change, and following the decision of the 82nd Legislature to withdraw almost 80 percent of its investment in programs intended to increase the state’s primary care workforce, we believe primary care in Texas is in desperate need of something like that landmark omnibus package of reforms and initiatives. Let’s call it the Primary Care Rescue Act. Obviously we would want to include the restoration of state support for GME, especially the funds that go directly to family medicine residency programs through the Texas Higher Education Coordinating Board. Also we would include full restoration of funds for the Statewide Primary Care Preceptorship Program, and the Physician Education Loan Repayment Program. But what else should we include?
We wish to engage you—the membership of TAFP—in this endeavor from the very beginning. What state reforms would make your practice easier, more efficient, and provide better care for your patients? What kind of administrative simplification requests should we make in state programs? What about managed care reforms? Would a standardized pre-authorization process help? Standardized contracts? Real-time claims adjudication? What could the state do to make primary care more attractive to medical students?
The sooner we can begin to craft a set of reforms to use during the election cycle, the more likely our success becomes. Remember, politics drives the process that sets policy. That’s why we want to hear your ideas for the Primary Care Rescue Act. Use this space, here on the blog, to comment with your ideas, and we’ll pay close attention to the discussion. If you’d rather send us your ideas individually, feel free to e-mail me, Jonathan Nelson, at email@example.com. Or you can e-mail Tom Banning at firstname.lastname@example.org, or Kate Alfano at email@example.com. However you choose to share your ideas, we are eager to hear them. The legislative interim can be a time filled with promise and hope, and it’s the perfect time to lay the groundwork for big initiatives in the next session. Let’s take advantage of that opportunity.