1. Danny Hood MD

    I share your misery and joy of working near home in a rural hospital. It is my greatest joy but at times my worst nightmare when I can’t get a patient to a facility where teritary care may save a life. I have realized that this is where I really am needed the most. Thanks for your words of wisdom.

  2. Teja Vasamsetty

    Thank you for speaking up for the rural physicians. I am happy to see you advocating for the responsible use of “second set of eyes” and respecting that YOU made the decision to order those tests or make the vent changes, etc. with some help over the phone. Thank you for explaining why it is simply inappropriate in most situations to quote the physician on the other end.

  3. Brooks Watson

    I worked full time at a rural critical access hospital for over 6 years in the Yakima Valley of Eastern Washington. I couldn’t agree more with your well articulated experience and struggle that comes with rural hospital medicine.

  4. Jeremy Graham DO MA FACP

    This is an important piece of clear writing; emphasizing the crucial yet insufficient Empathy in our inter-facility interactions (IFT), and also Professionalism (even just fundamental Decency). I’ve worked on this topic, but like others, usually “from the other end” of the IFT. THIS valuable short essay, written from the Rural doctor thinking Compassionately about the “…city-mouse colleagues…” is novel, needed, and I hope is shared widely.

    We KNOW that IFT is a big deal- that IFT is (case-adjusted) independently associated with worse outcomes; and that insufficient communication probably contributes ( Even when my time was spent in a GME teaching context, working to empathetically improve the IFT landscape, Dr. Menet’s essay is the first and best attention I’ve encountered that speaks FROM the Outside Hospital.


    I hope this essay is pushed to the top of the now-constant “feed” of professionalism discourse. Kudos to Dr. Menet for this clear and important piece.

  5. Mark Menet M.D.

    Im humbled that this article has resonated so much with everyone that commented. thank you so much for your kind words.

  6. Matt Hanserd, MD

    I’ve worked on both sides (both accepting patients at a tertiary and doing rural hospitalist for 9 years now). It’s really easy to be upset with “outside hospital” when it is where your work comes from. Just like we also blame the ER for not completing work that may be in our wheelhouse.

    We need to learn to put ourselves in others’ shoes and remember that doing the best thing for the patient is necessary.

    It is a risk reward situation where “best” may include staying at the rural facility or working out a process where they can transfer back after procedure.

    I assure you, none of us want to call and “dump” our patients on you. It actually leads to even more work than we are already doing and stretches thin staff.

  7. Andrew Mahtani, MD, MLS

    Excellent article and important topic.

    I oversee multiple programs, and work in each of them across 4 states. I enjoy the community programs more so than the tertiary facilities, in large part, due to the close relationship ships between collaborative departments, nurses and neighboring programs. It affords the opportunity to manage a broader variety of diseases and hone my critical care skills as we support our EM colleagues on all patients boarding for critical transfers that often take up to a week, where we will often discharge the patient from the ED when they improve.

    The challenges mentioned in the article are heightened, with more end of life discussions due to inability to transfer or patient preference to stay local. Additional challenges in some remote sites have been delays in labs, faulty systems with reporting of send outs (micro), and limited diagnostics to shortened hours and limited nursing and pharmacy support that narrow diagnostics and capacity.

    Fostering relationships across practice lines and systems have been helpful in a pinch and in bringing solutions to a daily challenges.

    The focus is on supporting the patients and each member of our site’s, system’s and region’s team(s).


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