- The Happy Golden Years, Practicing Medicine on the Prairie
I live in a not-so-little house on the Konza Prairie, the largest remaining area of unplowed tallgrass in North America. Despite this area being home to extensive biodiversity, with over 576 vascular plants, 208 bird species, and 700 types of invertebrates, little human variety exists. Caucasian dominates as the largest ethnic group, with over 80% of the population identifying as white. A lack of variance can also be seen in gender; Kansas ranks 41 out of 50 states in regards to adults identifying as transgender.
This stark lack of diversity comes as no surprise to me. I come from a small rural community in central Kansas that possesses many similarities to where I now raise my own family. A negative experience with a pediatrician as a child pushed me towards healthcare, nothing quite screams poor bedside manner like your doctor sitting on you with his backside to look in your ears! I became set on the medical path when I realized venturing out of my small community to become a physician held potential for what I could become. These experiences and strong determination early on prepared me for the realities of small-town healthcare such as a lack of diversity and a close-knit medical community, equipping me with firsthand knowledge to pass along to fellow rural practitioners.
Diversity tends to be a weighted word in today’s society. Merriam-Webster defines diversity as “the condition of having or being composed of differing elements.” In this small town, the condition of being different tends to have consequences. Differences can mean anything from not conforming to traditional gendered appearances or having a medical condition that cannot be treated locally. My first transgender patient pushed me to expand my medical knowledge while simultaneously causing me to have a sense of disappointment for how my community was unable to properly treat these individuals. Rather than referring them to an endocrinologist, someone who would have had specific training in hormone management, I had the forced opportunity to research and learn about dosages, regimens, and side effects. This expansion of my clinical skills has put me on the map in my small community; I’m listed at the college’s LGBT resource center as a queer-friendly provider.
While I enjoy expanding my knowledge, I worry that not having local specialists may impede on the level of healthcare that some patients are able to access. A middle-aged woman diagnosed with sarcoidosis comes to mind. She needed to see a specialist in a city two hours away for her complex rheumatology needs. Due to her chronic pain, sitting in a vehicle for two hours did not prove to be a welcome option. With a complete lack of alternatives, she had no choice but to make the excruciating car ride (twice) to receive the care she needed to develop a comprehensive treatment plan.
Some specialties are largely represented, as seen in the large local pediatric practice in town. They employ eight pediatricians with diverse backgrounds. However, since they are joined within the same practice, everyone follows the same set of rules and guidelines. The negative consequence of only having one group came to light recently with their new policy requiring every child to be vaccinated in an effort to protect vulnerable children within their practice. If a child falls behind on their vaccinations or the parent declines to vaccinate due to personal beliefs, the patient is dismissed from the practice. While their practice as a whole benefits from this new rule, some children are left without local medical care as a result. This is a parental decision, but the children can be the ones who suffer. The next nearest pediatric group to us is an hour car ride away. As a result, I have chosen to take on new pediatric patients despite having been closed to new patients for years. Telling them “no” is not a feasible option as patients like this remind me why I entered healthcare to begin with: to help people. Maintaining flexibility has proven to be vital in a small community, as often times, you must work with what...