Week 4 reflection

I'm sad that I have to leave Baker in a few days, but I'm so thankful for the time I've been able to spend here. It's also nice knowing that I'll be coming back (and this time with Mike!) for a rotation next January. What's really awesome is that we will be joining Dr. Schott and the gang on their annual medical mission to Honduras.

It's been a great week. A busy week. As I've mentioned in previous posts, the scope of practice of Dr. Schott and his colleagues is quite astounding. We go from delivering babies to admitting patients to the medicine unit to seeing patients at EOMA to seeing patients at Pine Eagle to attending hospice meetings. And we see so many types of patients, ranging from complex geriatic patients with several chronic conditions to more straightforward acute presentations to well-childs and so much more. That's the beauty of family medicine for ya. :)

Carol posed this question to me: "How much of yourself can you see in these rural docs?" and I've been thinking about this for quite some time now. I think that my enjoyment here has a lot to do with how much I enjoy being with my preceptors. I enjoy spending time with them in clinic as well as out of clinic. I feel like we share similar values and interests, professionally and personally. For instance, in the context of medicine, I feel we all value relationships, continuity of care, comprehensive care, and understading our patients as whole people (values shared by family medicine doctors both rural and urban it seems). More broadly, I identify with the emphasis these doctors place on community, at the clinic and in Baker as a whole.

To echo what I've stated previously, the old adage that "everyone knows everyone" in small towns rings true based on my experience in Baker. This has pros and cons of course, but I've found that the positive aspects of this phenomenon outweigh the negatives. Indeed, one of the most meaninful aspects of this experience has been the opportunity to get to know my preceptors, the rest of EOMA staff, and my patients so well since I see so many of them on a regular basis. A sense of community pervades EOMA and Baker as a whole.

I wonder sometimes if I am romanticizing the "small town" thing. My preceptors have been honest with me about some of the disadvantages of living in a small town, and I appreciate their candor. I feel it helps me paint a more complete picture. However, I've found that my experience in this rural community has been an overwhelmingly positive one. I feel that my preceptors' values and ideals resonate with me, and I share their love of this lifestyle and this beautiful land. It feels so good being able to just look out into infinity and be surrounded by mountains. Indeed, we are in the mountains. Baker's elevation is 3,451 feet afterall. It's so grounding being here, and I love that everyone is so close to the land. Side note: at the Kelleys a few weeks back, I was told that "everyone who moves to Baker eventually buys an animal or two. And dogs and cats don't count." We're talking horses, cattle, sheep, llamas, goats, pigs, chickens, and the like. :)

Another thing I've been thinking about is how progressive EOMA is. They are a patient-centered medical home, something we've learned a lot about from Dr. Saultz and others at OHSU. To see a PCMH in action is exciting. This innovative model is defined as follows: "The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner." Similarly, at EOMA, "Our philosophy is simply to treat you as we would want our family to be treated. From our receptionsists to our providers and management, we aim to provide the highest level of care we can with a sense of caring and compassion. In trying to achieve this goal, we have attempted to design the clinic and its flow to optimize efficiency and comfort. As you will see, this may mean encountering new ways of doing things that we are all going to have to adjust to. The changes we feel will help improve your access to the providers and our access to knowledge."

Dr. Schott really does embody that first phrase, and treats his patients as if they were family members. I can tell that his patients appreciate this and that he is well-loved and respected by his patients. Dr. Schott is incredibly hard-working, and several of his peers have recognized this as well. In fact, last night, I had a chance to meet Wanda, mother of Mercy (owner and landlord of my apartment and sister of one of Dr. Schott's best friends), and she shared glowing remarks about Dr. Schott, "Jon has always been so hardworking. I'm so happy that he became a doctor. Baker is so lucky to have him." It's not uncommon for me to hear comments like this from several of Dr. Schott's patients and friends. From what I can tell, it seems that the other physicians here are also greatly admired and respected by those in the Baker community, and it's an honor to be working with them.

Back to the PCMH, Jacque Cobb expressed, "What's great about EOMA is that we have doctors that have traditional values, like family and relationships, who are also really progressive when it comes to the way they practice medicine." Well said, Jacque. I've noticed that all of the docs here are incredibly up-to-date with regard to patient care. On more than one occasion, I've heard, "An article just came out a few months ago that says [this treatment] is better than [that treatment]..." or "A study published a few weeks ago indicated that a more effective treatment for [this condition] is [this lifestyle change] in combination with [this medication.]" In this way, their practice of medicine is truly evidence-based and cutting edge. It's wonderful to see this juxtaposition that Jacque described of traditional values and progressive practices. I think these doctors are providing excellent care, and their patients are happy to boot!