Specialized Generalists and Remote Medicine

RemoteI have been a bit absent from writing on the blog lately due to gathering up paperwork, evaluations and the like.  This is because yesterday was my last day of being a resident doctor!  I am done with my official training and very happy to write that!

Specialized Generalist

Being a life-long learner is something that is aspire to.  This means to me that one does not stop their learning and educational process, just because they are not in a formal training setting or classroom.  I realize that my formal training is complete but that the field of medicine I have chosen requires continuous learning, review and scholarship.   I am very fond of the term “specialized generalist” and like to consider myself within this scope of medicine.  I am not going to be the best physician in any specific area.  I will never be a premire cardiologist, vascular surgeon or infectious disease expert.  Being a physician trying to specialize in general medicine requires a very unique skill set and knowledge base, drawing on all disciplines of medicine.  The scope of practice is just that…general.

Taking care of persons in remote areas of the world, often in resource poor conditions requires a very broad and general knowledge of all medical conditions.  The joke I always say is that I will be considered the worst doctor, by all the specialists.  I am not an expert at the conditions I will be required to treat.  My conversations with friends in their respective medical specialities often illustrate to me just how little I do know.  I frequently make use of their vast knowledge in their respective areas and try to learn from them as much as possible.  A generalist must never get complaisant in their knowledge, as it will never be enough.

Through my residency years I have tried to gather my procedural skills and knowledge base around this type of practice.  I am not a general surgeon but have performed my share of surgeries to remove an inflammed appendix.  This is a basic surgical skill and easy for my surgery friends.  For me, as the only physician in the area, it will be harrowing but I have gotten exposure to do this procedure.  The same can be said about both vaginal and Cesarean childbirth.  I am by no means an OB/GYN doctor.  However, I have completed a decent number of both vaginal and surgical childbirths.  Should there be a patient with this need and no other physicians around, I will be the one called to perform this procedure and ensure safety of both mom and baby.  By no means can I consider myself a pediatrician but I am versed in treatment of newborns and children.  The reason that I am called upon to perform this type of care is by a fact of location and lack of access to specialized physicians. 

Remote and Expedition Medicine

Explorer in ActionLooking after the health of those who are far from medical care is my passion.  Frequently, there are no other doctors within hours of air-travel, let alone hospitals to treat them.  I have an obvious interest in caring for adventurers who enjoy travel to these remote locations.  Travel and Expedition medicine draw a great deal of their procedural skills from Rural Generalist physicians.  These rural generalists are the docs who are required to be the “only doctor” for their area, attempting to fulfill all the medical needs of their patients.  Adults, children, surgical, medical and mental health needs are merely the beginning.  One of my favorite quotes about this type of medical speciality is “The rural doctor is one who is chewing more than can be bitten off”.  To me, that exemplifies the profession!  A remote medical doctor must be comfortable working outside their comfort zone, working in a resource poor environment and continually learning in all areas of medicine.

Residency Training

A resource poor area does not have access to many of the modern medical instruments such as CT scan, MRI and 24 hour specialist consultations.  Physical exam skills, experience and telemedicine consultations are required in such areas.  Knowing this, I choose to train at a VERY large hospital in Chicago.  My training was at a facility with all these conveniences.  For me, the decision to train there was a tough one.  I did have the opportunity to learn from all of these specialists.  I was taught surgical skills from exceptional surgeons and had access to a large number of cases.  The same with pregnancy and childbirths.  What I did get access to was a large volume of cases under the supervision of world-class specialists. 

From the beginning of my training I informed my teachers that I planned to work in these remote and resource poor areas.  Fortunately, they were very supportive and attempted to impart to me their skills and what I needed to know for this unusual practice location.  I received extra attention in the fields of surgery, anaesthesia and critical care of both adults and children.  Often times, I was literally taught what to do when things go horribly wrong, how to stabilize the patient and the basics to get the job done.  This was then augmented with extra time devoted to “hands on skill”.  Most of my fellow residents in their respective specialities were all to eager to give up the “basic cases” of appendectomy, primary c-section, epidural anaesthesia and trauma management.  This was because, for them, these cases had all become routine and quite basic to them.  For me, this was perhaps my only opportunity to deal with such procedures under the private tutelage of my expert instructors. 

Future Plans

thailand roadI am very close to moving from Chicago to Southern Arizona.  I have plans to work in a rural, single physician coverage emergency room and do some locum tenens (temporary) work at various locations through the US.  All these locums positions will be in remote ares and often resource poor.  I also plan to do a healthy amount of international work, serving as both an expedition doctor and humanitarian responder.  There is also going to be my own travel medicine clinic opening soon, as well!

Writing about medicine is another passion of mine and I plan to continue this.  In fact, I am preparing to make some dramatic upgrades to my website and blog in the upcoming months.  Changes will include publishing much more information on travel and expedition medicine through a book I have written and plan to publish for free on this website.  I am currently working to design the new site and make it much more “user friendly” and allow for visitors to easily find the information they are searching for.  I plan to continue blogging about news related to keeping travelers and adventurers healthy.  The new site will also include some new forms of media, in addition to standard text.   I hope that all visitors to my site check back-in over the next few months and enjoy the changes as they are completed!

Thanks to everyone who reads my site, leaves positive comments, those who have published my writing on other websites and most importantly:  Thanks to all my wonderful instructors who were so patient with me and helped increase my fund of knowledge.  I hope it goes to good use!

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