I strongly believe all med students/residents should do a rural rotation, even if they have their hearts set on academic CT surgery and have zero interest in family medicine or rural medicine ( /thread).

Too many times have I heard medical providers bashing transfers from the dreaded "outside hospital", scoffing at these "podunk rural family docs" and how they don't know anything about medical management.

Why didn't we get an foot MRI for this patient with potential osteomyelitis? Well MRI is only here on Mondays. (And let me tell you, it's an ORDEAL getting patients into that mobile MRI machine in the parking lot.)

Why didn't we try bi-level on this acute hypercapneic patient before shipping her out? Well, we don't have an ICU or ventilators. We only have a single makeshift CPAP that plugs INTO THE WALL and barely provides any PEEP.

Why is this discharge summary so hard to follow? Well, providers struggle with a clunky EMR every day because the hospital can't afford Epic.

When I went to #Chelan to work with @kbbergeson, we took care of a patient in diabetic ketoacidosis. I naively asked where the DKA Powerplan was. Turns out, I had never truly managed DKA. I just clicked a Powerplan, checked K+ levels once in a while, and let the nurses handle it.

When rural hospitals transfer patients, it's usually not due to lack of medical ability - it's lack of resources. I wish you could see all the pts we DID take care of. The trimalleolar fracture we reduced in the ED. The finger we sewed back on. The beautiful baby we delivered.

Rural providers take care of some of the country's most vulnerable populations. Indigenous populations. Migrant workers. Communities cloaked under centuries of generational trauma. They are fierce advocates.

Rural providers are resourceful and resilient, and above all, dedicated to their communities. So please think twice next time you roll your eyes at an "OSH" transfer - there's more than meets the eye.