A Rural Hospitalist to the Core


This article and the related comments are for educational and discussion purposes. They do not establish the standard of care in every patient’s situation. In each patient’s situation, the treating physician or other medical professionals must exercise their professional judgment. Similarly, these materials are not medical advice to patients, who must consult with their own physician or other medical professional.

“Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.”

– Margaret Mead

My first Apogee practice experience was in a rural hospital in Southern Oregon. Practicing there, I became a better doctor.

In rural hospitals with limited resources, the importance of excellent clinical skills and practices is heightened. Who stays, who goes, and what, exactly is going on? How can we fashion the best discharge for this patient?  Practicing in a rural hospital sharpens clinical and practice skills through the strengthening of what I call “the core skill set” of hospitalist medicine.

In hospitalist medicine, my formulation of core skills includes these elements:

  • Creating a trusting relationship with a person who needs your time, attention, and skills (the patient obviously, but also the nurse, case manager, specialists, etc.)
  • Collecting and sifting through history, physical exam and test results pattern match and or analytically arrive at a working and differential diagnosis
  • Ordering appropriate treatments based on science and the patient
  • Partnering with the nurse to monitor for progress, or lack thereof
  • Creating safe transitions by working with discharge planners and all who receive the baton
  • Discharging patients who will do better with their plan of care and have better outcomes because I gained their trust, listened to them and gave them my best advice.
  • Improving, always improving

The above “core skills” are combination of factual knowledge, retained disease patterns, communication style, emotional intelligence,  culminating in practice habits that align to enable us to achieve our highest purpose of using our training and experience to help others with difficult, consequential problems.  While these core skills are critical in any practice setting, they have a bigger impact in rural hospitals because teams are smaller. The return on investment of time and energy is higher because every team member’s contributions are more consequential.

Of course, hospitalist medicine is a calling, and for the right people, that calling is impossible to resist. As Apogee founder and CEO Dr. Gregory says, “All people need to be cared for, but you’re different, you have the need to care for others.” So, we chose to study longer and harder, and to put ourselves into situations where we did not know enough and where every day was a chance to learn, but also an opportunity to be humbled. We studied, learned, and gained experience as we developed patterns of practice that allowed us to succeed in high-risk-high-reward situations. We went into hospitalist medicine because we liked to solve difficult problems using our training that would help people live better lives.

Rural hospitalist medicine accelerates personal and professional growth. I became very aware very quickly what I knew, what I didn’t know and what I half knew. Those insights are ingredients to wisdom, and rural medicine is the kind of practice experience that made me a wiser clinician, communicator and team member than I would otherwise have been.   


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