“Welcome to Lanark – Population 800″; I spun my head around to read the sign as we drove by. I had not previously appreciated that when my preceptor referred to Lanark as “the village”, this was not merely a metaphor of endearment – she had meant it quite literally.

“Week in the Country” is a program sponsored by the government of Canada to entice medical students towards rural family practice. Every medical student is required to spend at least one week shadowing a rural Family Doctor. Almost all expenses are covered, as our government is desperate to meet the growing need for doctors in under-serviced rural areas.

Lanark has one major road running through town. We were lodged extravagantly at a bed & breakfast (see photo above) on one side of town, and walked into the Community Health Centre on the directly opposite edge. The walk across all of Lanark took no more than 20 mins.

4 year-old male presents with left ear pain lasting five days, and other non-specific symptoms of an upper respiratory tract infection – our first patient. It is surprisingly difficult to look into a squirmy child’s ear! Otitis media; Amoxicillin 50mg/kg/day TID x 10 days. After Week in the Country, I can now write that with some confidence! In fact, the week was extremely valuable for gaining some proficiency at triaging common complaints, and I am now more confident in differentiating sore throats, sinus infections, headaches, and common skin rashes.

Perhaps the most memorable patient, for me, was an admirable young man trying to quit smoking. He had impressive resolve, but was profoundly impeded by addiction. I cannot imagine the frustration of fighting a war with your own brain. I learned about the arsenal of medical tools available to help. More powerful, however, was when my preceptor offered to make an appointment with this patient every other day on his way to work for the next month – a brief check-up, so that every two days there would be someone asking “Have you had a smoke?”, and “How is it going?”. What a privilege to be that source of accountability and motivation in a person’s life.

In Lanark this week I didn’t get into the OR, or the ER. We didn’t see anybody who was mortally ill. We didn’t perform any cowboy, daring, rescue procedures. But I’m not in the least disappointed. I learned how to swab a throat, how to give a vaccination, and how to detect pneumonia without the luxury of an x-ray. Less romantic perhaps, but unaccountably more useful.

Not long ago we asked our Family Medicine professor (a pragmatic, and sometimes playful clinician who we devotedly revere) what are the top five recommendations that he would make to his patients for their general health. His top five were echoed again in class this morning by an Infectious Diseases specialist, and seem to be a good consensus, so I thought it would be worthwhile to share them!

1. Exercise regularly.
2. Eat a diet that is low in fat, and high in fibre.
3. Don’t smoke.
4. Get enough sleep.
5. Practice monogomy, and use condoms.

I spent the afternoon today in a clinic downtown observing a Family Doctor! What a meaningful way to remind oneself about what’s waiting at the end of all this studying, and also why it’s so important to learn everything that we’re being taught! During my observership I:

• Listened to a premie baby’s heart rate: SO fast!!! It becomes nearly impossible to distinguish the individual heart sounds.
• Looked into a little girl’s ear – she was so brave and sat very still! Unfortunately she has had multiple ear infections recently, and so maybe she is getting used to strange big people poking scopes into her ears.
• Saw a bite that may have been from a tick, although it didn’t look characteristic of tick bites
• Learned the technique for giving a flu shot. This time I was just watching, but the doctor warned me that next time he wants me to try it … scary.
• Observed a few well-baby check-ups to monitor growth and development. One was with a VERY hyper two-year-old. He was literally climbing the walls !
• Listened as the doctor explained to a patient that he would need to start taking medication for his blood pressure… and learned something from the very difficult discussion that follows a diagnosis of hypertension about exercising and eating right

Family Medicine is a neat speciality because you really get to know your patients, and, well, their families ! Seems obvious eh? But increasingly I’m realizing how rare an opportunity that is in medicine. There’s also a lot of variety in Family Meds, both in the types of patients that you care for, and the types of complaints that they may have. But perhaps what I find most attractive about Family Meds, is that you get to have those longer conversations with your patients where you answer random questions that they have about their health, and work through issues that really matter to them. There is a true partnership at play.

Anyway, what an illuminating day! I rounded it off by going to an art show put on my classmates, then some quick swing dancing, before I now must buckle down to some work.