At the end of first year of medical school, it is mandatory to do a one week elective in a rural placement. I was placed in Sturgeon Falls, a tiny town that takes about half an hour to walk all the way across, which is part of a “larger” area called West Nipissing. I say “larger” because the entire thing is only about 14 000 people total. To give you an idea:
And here’s a few pictures of where I was staying…they have an apartment for the students who come to do placements here
The people in Sturgeon Falls are the very definition of bilingual. Pretty much everyone speaks both English and French, and switches casually between the two, often mid-sentence. For someone like me who is comfortable in French but sometimes has an easier time expressing certain things in English, it’s a great place for me.
A lot of the health issues in this community are stemmed from low incomes, a lack of jobs and ultimately a lack of things to do. There is a lot of obesity and a lot of mental health issues. That being said there are a lot of resources here. They do have a hospital, a Family Health Team, the Community Health Centre, a Family Resource Centre as well as retirement and nursing homes and home care.
I shadowed a doctor at the West Nipissing Community Centre. They have 2 doctors, 3 nurse practitioners, a dietician, a respiratory therapist, physiotherapy and a counsellor who additionally counsels on financial matters. They also run various programs like lung rehabilitation, yoga, meditation and more. The patients coming to the centre are essentially using it as their primary health care, as none have family physicians. If they’re coming to the clinic, all the other resources (dietician, programs etc.) are completely free, which is a big benefit since most people here are not well off and do not have insurance.
I’m happy to have done this at the end of first year, because I did actually understand most of what’s going on! The doctor I worked with takes mostly older patients with very complicated cases. Main things she deals with are: chronic illness (cardiovascular disease, obesity, diabetes), chronic pain (fibromyalgia, arthritis, cancer, and a lot of mental health issues (depression, anxiety). What makes these cases most complicated is that they all tend to occur together in the same person!
The advantage of being at the placement for a whole week was that you really got to see the variation in practice. Obviously there was a wide variety of cases, we worked in both the clinic and in the hospital. But you also got to see the highs and lows of practice. Three times I had to hold back tears of joy when patients had such wonderful success in their treatments and life was coming back together for them. Twice I had to hold back tears of sadness, once as I saw a patient get a cancer diagnosis, and another time when an elderly lady came in with crippling pain.
And that’s just the times that I cried! I saw lots of patients cry in their appointments. To me that’s a testament to how much trust they put in their doctor. They are not afraid to tell her exactly what’s going on, how much pain they are in, how much their illness is affecting their life. It’s clear that they feel they will not be judged, their concerns will be heard, and the doctor will do everything possible to help them. I know that is the way that I want my patients to feel when they come into my office some day.
There is a huge difference between the way that I have seen family medicine practiced in Ottawa, and the way I saw it practiced here. For starters, the appointments are generally much longer, with the doctor I shadowed taking at least 15 minutes, but more often 30 minutes. In the city I mainly saw people who were specifically coming in with one complaint. The doctor would briefly check it out and asks for test or prescribe a treatment. Here, a large part of the appointments were to follow up on their chronic issues and make sure they were managing well. If they did come in with a specific complaint, once she had dealt with that she continued to follow up on any long-term issues, bringing them up and thoroughly going over them even if the patient didn’t bring it up. Then, she would schedule follow ups. Every patient she saw left with a follow up – maybe one week, one month, three months. But I can definitely tell you she’s doing a better job of following her patient’s health status than most city doctors (also note though, she has many less patients!). One time there was a woman who wasn’t feeling well enough to come in, she went to her house to follow up, and good thing too, as she was having some serious cardiac problems. I found that she was also incredibly perceptive, picking up on little cues and making sure to question about them to make sure there was nothing lurking. If the patient had come in with a previous diagnosis that she didn’t quite believe, she wouldn’t hesitate to investigate further and get to the bottom of things. She clearly understands the importance and strength of mental health issues. All of these, things I really admire.
I also had the chance to shadow the nurse practitioner for an afternoon. One thing I have to admit I really liked about this particular nurse was that she was always very careful about medications. Always double checking side effects and interactions before prescribing, and explaining everything to the patient very thoroughly. Perhaps the doctor didn’t go through the research process as thoroughly before prescribing because she was more familiar with the different interactions etc. But overall I feel like we should all be a little more like this nurse – better safe than sorry!
The interactions between patient and doctor are also much more casual here. Perhaps that was mostly at the Community Health Centre because that’s just the personality of those people. But, for instance, doctors and nurses would hug their patients. They would use language that was much more casual. And I liked that a lot. I feel like it put the doctor and patient on more equal ground, and probably put the patient at ease also.
During our time off, we didn’t have much planned. We mostly went and sat down at the marina. On our last day, the President of the hospital (who happens to be the mother of one of our classmates) took us for a little hike, then we decided to rent a pedal boat – what a disaster! We didn’t realize how strong the current was, and weren’t at all able to get ourselves back to the marina. We ended up asking some kids to help pull us behind their motor boat, but our boat started filling with water. Finally, they dumped us on some guy’s dock, and he drove us back to the marina, leaving the boat there to be picked up later. My god. Can you tell we’re from the city?
Over all, it has been a great week. I’ve seen a lot, gotten the chance to put my knowledge into practice, and have experienced a form of practice that I really like. I hope I’ll be able to do some rural work again in the future, because I think it just might be the right place for me (not necessarily Sturgeon Falls…but somewhere rural).