The thing which differentiates a small community and its lifestyle from a large town or an urban area is probably the importance of people everybody in a small town is necessary and is important and contributes to other people's welfare in an urban area there 20 people waiting in line for everybody's job or scrambling to get a hint. I think people who understand and are able to accept the importance that they must assume in small-town life are the ones who do it successfully. and this I think is going to be it's going to be interesting to see if it if it really does help us keep doctors and other Professionals in that that roll throughout more of their life yet certainly makes a difference as to whether you have an appreciation if he's a baker or a farmer or a car dealer or what this man is involved in in and what to his family style and what his his previous lifestyle was like before he came to have the condition and then can we improve or or retain the quality of this person's life while you got to know what that quality was and how he do that his expectations in and so yes, definitely you can know your patients better from that Viewpoint know what their expectations are with regard to the quality of life because I know it back in the larger hospitals in Very important part of the history and physical on a hospitalized patient is a social history or a patient profile or whatever. You want to call it where you attempt to get some insight into the patient's views and expectations regarding lifestyle. And this often times so it just comes across verbally and there are many different ways of communicating and if you can communicate on various levels and communicate it at different times not just one setting like in a hospital and know this patient you can know so much more about what he expects out of life what how he views life what his lifestyle is in knowing that then you can help him manage his disease or his condition to a point to attain as closely as possible alive stylus compatible with his expectations. So they won't be eggs and anxiety produce then when this is met for Physicians for Primary Care and so I I'm I know they're many needs in Minnesota and it most likely would be a real area someplace where they have a shortage of Physicians or are unable to cheaper maintenance position I think that practicing in a small town is going to have problems with practice anywhere if we have problems and it's just it depends on what problems you're willing to tell you going to a city where there's lots of doctors and and there's problems there too. You know, you may not have a big variety of patient types who tend to go into Specialties and if that's what you want, you know, I suppose that would be the kind of things going to a bit as real a real need for family practitioners and it's it's really challenging. It's much more Talent most people really admit that they go into Specialties cuz they're a little afraid or or would go into Specialties because there are no a little fearful of the variety of things to But they would have to know as a family practitioner. A sense of place a documentary series, which looks at regions and regionalism in the state of Minnesota produced by Minnesota educational radio under a grant from the Minnesota Humanities commission. This program is called the new doctor on Old Main Street. the problem is when you get there, you have an appointment usually. in the waiting poem I can see of an appointment to get there and get the job taking care of in that wait an hour or two hours. We had this problem. Three years ago on their son broke his arm. In the head didn't take the specialist in Saint Cloud. There are instances where we waited two hours before we saw the doctor. Are you can't really afford to lose that kind of time not on the farm. I mean, I didn't see I don't see anything because I feel that he's a busy man to visit him. And he just puts in his 8 hours. I made him going once or twice a week. He's an emergency call. In this visit this situation these doctors were in a group. There's more than one involved. So I felt it. They're so far behind. What is an X-Men pitch in and help him on a small town people experience when they seek medical care and Vella disease complaints are we all ran away fortunate to be able to make some because in a lot of places in this country many places even in this state you can't complain about how long you said waiting in the doctor's office. There's no office to sit in no doctor to see Physicians just haven't been locating in rural areas lately. Dr. Robert Carter dean of the medical school at the University of Minnesota Duluth Medical School here in the Duluth Campus of the University was started by the Regents University Administration in the legislature to try and do some very specific things for many years. There has been a shortage of doctors in the rural parts of Minnesota. The metropolitan area has about two-thirds of the doctors to serve half the population ones that are left for the other half of the people in, Minnesota. In addition to the shortage and absolute numbers. There is a very severe shortage in several types of doctors. This is most marked in the people doing general medicine or Family Practice. The number has been declining year after year in all parts of the country and a soda is no exception and it's reached really critical proportion. The regions in the president of the university and everybody hoped that this program could endure. Both learn more about training people for this type of practice and could expand the total production of of doctors by the university in 80 close to 400 freshman medical students and during training each year will be needed to meet the demand for physicians in Minnesota and to approach a solution to the problems of health care for real parts of the state where those young people will come from and the kinds of educational experiences that will be provided Them Questions being considered today in programs, like the one at the Duluth campus and in the rural Physicians associate program, which is operated out of the family practice Department of the University Inn Minneapolis intellectually able and well prepared to do graduate work. There is no substitute for intelligence and proper application of this in in a health science in addition to this. However, we're looking at certain characteristics with in people which we hope are going to be important. For example, we know there has been a great migration of people from rural areas into urban areas in this whole country for many many years fascinatingly. There is been really no counter migration people born in the urban areas almost never go back to a rural area for a prolonged. Of residence or work. Although there are a few exceptions, of course, but the odds are overwhelming that the people who stay in a rural area. started there or at least had some early experience in their life, which showed them what it was like Many of the things in life, you know that we do we do too late. I think Joseph Conrad said and in origin there's never time to do the last thing or say the last word in anything that you're going to do never I think is this more true than in a person's training if you start too late or if you count on last experiences, they more often than not fail. As with our children our own children, we simply don't realize that much of your life pattern is established very early in your life. What you feel comfortable with what you understand and what you feel has value are things what you experienced. Either as a preschool child or in your earlier years in school many of them, of course were values with your parents transmitted to you consciously and unconsciously. For this reason we are very much interested in attracting people into this program who have had early experience. And what life in a smaller Community is really like these are the young men and women who will understand and these are the people who can participate in an inducer comfortable. It is true that is knowledge increases as rapidly as it has been. that we are seeing very very strong forces towards specialization in every profession School teaching chemistry medicine and so forth and so on engineering it is equally true that we must retain generous in all professions. Otherwise, you have such a fragmentation of service in so little communication between specials that the patient is in a hopeless maze. They really don't know how to sampler partake of things. The real issue appears to center around what you can inch occasionally do to to keep a person as a generalist. You must not only start with the right raw material, but you you must do everything you can to properly train them for this role. I think this is basically the University's interest and in this program it it's an experimental learning model to find out as much as we can under very carefully controlled circumstances how to do this job of Education. We may not succeed but we surely are going to know why we failed very well if we do fail in finding an important advance in this I think so, we probably will succeed more than we will fail and it's already becoming apparent that anybody be they are radio engineer be they of a professional actor or actress or this. Maintains a general rule if they have a strong feeling of confidence and ability in them self confidence in what they are doing. It has to be realistic. They can can't think they do things. They can't but a realistic self-esteem and confidence in their ability permits somebody to play a broader roll. So what we're doing with these student is making sure that they learn under his good circumstances as we can. They real concepts of the basic science. They must apply to patients and that they will come out of this. knowledgeable practitioners confident in their knowledge and willing to to use it in a broader field of application sr2 young physicians in training in the Duluth Family Practice program. They reflect on some of the situations they can expect to encounter in Medical Practice in a rural setting if you have a problem and you need some help and if you look around but it's probably two people that at least, you know, when I'm small such Town situation that you can go to there's your in Old Forge or there's your doctor. They don't have an extensive counseling services and and they certainly didn't wave at and if you just if you really start you mean you need help you need some outside consultation and somebody who's not necessarily personally involved. They knew you would Have to come to one of these two people and I think that's probably for a lot of it came from and then when you do get have a lot of people's personal problems on your shoulder then night. I think it's that to me somewhat of a barrier to getting too long get more personally involved with them. I don't you know, social level I guess. My concern is I think about it is again thinking about the other person know that I'm going to be coming in contact with him that I'll be staying in the hospital or will be coming to the office and I think just being a woman for one thing is going to make some people uncomfortable because the traditional role is a masculine one. I think nails for example are not readily at all is going to be inclined to come to a woman physician in that again is why I see another disadvantage for solo practice for myself and it wouldn't be able to be a partnership with other women. It wouldn't necessarily I think Comfort of the people that were trying to care for it have to be some kind of mail. partnership in some way I guess we've been warned by some of the women doctors here in town who has spoken to us, but probably after the age of 12, we won't necessarily see any male patients until maybe around the age of 60, so I think until Women are more. I don't want to say except it. But seen as Professionals in this area and people can be comfortable with either masculine or feminine position that. It's the people that will just have to try and get used to it and ourselves. We'll have to not take things personally either when people do not choose to come to us for one reason or other because women in medicine are still not that common and particularly and family practice. When I lived in small town. You have to go to the Rotary Club. Interesting because a doctor in a small community is a very definite social position. I think that's one of the things that I'm really impressed with with my classmates. Sometimes in Preston and sometimes I think it's maybe accentuated a little bit but I think if there's a mean theme in this group of people that I'm going to school with the theme would be one that there's a strong emphasis of breaking out of that social role. Why should friends of doctors necessarily have to be exclusively lawyers other professional positions are just other Professionals of some sort. Why can't they be just across cut of all the people in town just where people your people, you know, make friends that way instead of on a on a professional basis or I'm working career bases. So I think that medicine and general is is maybe moving out of that kind of the doctors has a social role to feel From the 1920s novel Main Street by Sinclair Lewis doctor. Will Kennicott talks about the problems of his role. Do you realize what my job is like around 24 hours a day in mud and blizzard trying my damnedest to heal everybody rich or poor you you that are always spilling about how scientists are to rule the world instead of a bunch of spread-eagled politicians can't you see that? I'm all the science there is here and I can stand the cold in the bumpy roads in the lonely rides at night. All I need is to have you here at home to welcome. I don't expect you to be passionate not anymore. I don't but I do expect you to appreciate my work. I bring babies into the world and save lives and make cranky husbands quit being mean to their wives and then you go and moon over a Swede Taylor because he can talk about how to how to put rushing's on a skirt hell of a thing for a man to fuss over. Anybody who is that, you know, it gets to know me from here on out will. He pointed with the fact of what I'm thinking of doing and I'm sure that you know, that's a lot of people out of the competition. You know when you have your plans laid out and you although I haven't got to know extensive plan. My future is somewhat definitely right now and anybody can get to know me after this will necessarily have to include that and whatever they're thinking and I think that that way our relationship would develop where we would not have that many problems. It would be somebody who would want to do the same thing tonight. I think the girls excluding myself have been talking about. the problems of possibly getting married to someone who was not turning the kind of salary that they were earning and would this be hurtful to their relationship and what kind of problems could result from that I think these are all very practical things that again need to be crossed when the situation arises then you really can't we plan any kind of an approach. I don't think you know, but the whole thing about people's maturity and thanks and specially now most of the people I know most of the mail that I have come in contact with his school cheer in college have a don't have the traditional outlook on life in all I'm going to be the man of the house if I want a little wife at home in the kitchen that type of thing is more prevalent now than 30 years ago. I'm sure I wasn't here 30 years ago. I just have a feeling that it is and Fac laptop many people have a working Orlando. Marriage is over. Both spouses are working that the people are happy. They're doing what they like to do. And neither one of them has to feel like he's being put on and I think the best type of relationship it will have to be and I think it's very possible happening. And another sequence from Main Street in which Carol decides to show an interest in her husband's medical practice. Don't I am looking for things to do to show that I'm not attentive enough to will am I impressed Enough by his work or I will be I will be if I can be one of this town if I must be an outcast. When can I came home she bustled dear? You must tell me a lot more about your cases. I want to know I want to understand sure you bet and he went down to fix the furnace. At supper she asked for instance. What did you do today? Do today. How do you mean medically? I want to understand? Today over there wasn't much of anything a couple of Chumps with belly aches and a sprained wrist and a full woman that thinks she wants to kill herself because her husband doesn't like her at all just routine work. But the unhappy woman doesn't sound routine just in case of nerves you can't do much with these marriage Mix-Ups. Please will you tell me about the very next case you do think is interesting sure. You bet tell me about anything that say that's pretty good salmon get it at howland's. Gopher Prairie Minnesota according to Lewis had a population of 3000 including the family of doctor. Will Kennicott Sauk Centre Minnesota. The model for gopher Prairie still has a population numbering about the same and for the last year, it has included the family of dr. Michael Bess who has been working with a local family physician. Dr. John Grant through the University's rural Physicians associate program. Driving up Highway 10 from the cities and across the new leg of I-94 that stretches West from Albany Dr. Best looked out over the same Prairieland immense vigorous harsh on soften. The Carol Kennicott saw some 50 years earlier, but he didn't feel it through her eyes by it. Read it while I was here, but then I thought well, I don't know if I knew that then I might formulate some opinion that subconsciously at least I shouldn't so I may read it when I get back. I have no idea what's in it, but I've heard that it's time. It was rubbish. It wasn't very popular here, but now San Carlos is quite popular hearings. Is a great deal of effort to being made by this community to preserve. Sauk Centre in his boyhood home what it was like Michael best no socks and her pretty well by now and the same light be said of Family Practice his association with dr. Grant has taught him a lot Grant has been in practice in this town now for 30 years and no there are so many things that that he has learned about dealing with people and dealing with diseases and injuries that could never I don't think ever be written in the text book and yet here you got first-hand access on a one-to-one basis and it's I kind of admire, you know that the fact that two a guy like this is a willing and able to help you with these things into the share real estate. Some of these things are just real pearls and when it comes to dealing with certain conditions in with certain people saying the community, you know, he's seen mrs. Or mr. So-and-so off and on for the last 30 years and and knows that this particular complaint, although it's not typical is referable to a certain problem and Carissa and fortunately when you just come out of training at you, if a complaint doesn't fit the the typical textbook pattern you can't come unglued. So what the book says, you know, Yellow be willing to say you know how that I don't care what the book says. It's it's really this way and you go on and you know, when you progress it and you follow along and then Done right through it. So it's really not that way and you can do more for this particular patient. If you follow his experience and it's all the positions here to not not just to dr. Grant. Although he is the preceptor that they've their generosity is really in. It's it's amazingly generous with their time and generous with the knowledge. Which you might say. They've come on the hard way because you know darn well, they didn't learn medical school because you didn't learn medical school and it works its way down the back and the boys senior was here and before in and he I'm sure I imparted certain things to these people when they were starting out and now there's some things you just must must be passed on. you know when you first go into medicine, especially especially popular now in I think especially true that you say you're not going to be a deity. You're not going to be an image. You're going to be a real human being and relate to your patients on that level and yet there are certain patients who do not care to relate on that level and who will not relate on that level and If you don't modify your thinking to take him to view and into consideration the patient's feelings. You may have difficulty dealing with that patient in the Way Madison is set up. It's it's a quotes free market in quotes a patient can go anywhere they want and if and if you attempt to deal with a patient on it and a very human level and they don't particularly care to be dealt with on that level you're going to lose possibly the continuing care of that patient and some of the most important things that can be done have to do with continuing carrots. It's a acute medicine is very exciting. And if so, very rewarding, but sometimes the only way you ever get me where is on a chronic basis and to get to see the patient repetitively and sometimes you never make a diagnosis until you see the patient, maybe three or four or five times and get to the root of things. You see just almost anything. I'm I'm continually amazed at the things that walk or the things like that come into the office and the course of an afternoon it and obviously I'm paying about the patients that come into the office, but the the the way things present in the way people present in the diseases that they presented in the office many of the things are are rechecks of say a follow-up a 3-month follow-up of a high blood pressure or something like that or an OB check something like that. We see are obese once a month in but many of the things to do. They're just absolutely you. Fascinating from my point of view from a scientific point of view in an extremely interesting from the human point of view you sometimes I'll get involved in talking to a patient's finity 45 minutes with one patient in this just put you behind and then the next time you go out and look at your charts waiting for you can just fall over but at the same time it's time that I think is very worthwhile. You spent maybe 45 minutes with a patient to finding out things about that patient and having him relate things to you that I don't think we'll come out in the other way and just sit there and in keep digging into the things that are deeper than what they superficially appear as I mentioned before it. It's not uncommon at all to have people come in and with some very minor thing and then after you look at that and reassure them that it's really nothing to to worry about the phrase comes out. The real reason I came here was to ask you about and then you know some very serious. Conversations go on in and some very difficult times for some of these patients because it's obviously something that they're having trouble talking about and if you keep your schedule right on that 10 or 15 minutes basis where you're obviously not going to have time you spent 10 minutes looking at the money or thing. You can spend five minutes on what it is. It's really bothering him. Why are times you can help? People simply by offering them the chair that sticks to your desk and tell you know, this is the place you can come to let's let's say is not a medical problem but Falls more into the realm of a family problem there something like that because this is something you'll spend a lot of time with our making it known to them that this is always available to them and almost always on a community and the various levels of communication New York first see a patient to sitting in a chair very rigid with their hand usually toward their face in their legs crossed and in various pasta Rings what you're very tense and is you talk to this patient and draw things out things have been bothering them. Are you here just watch the plastering and sometimes I draw this to the patient's attention. I'll sing out notice the way you're sitting on think about what it was when you came in and I was going to get a chuckle out of Why the time is it the main help you can give is to reassure her just to listen and try and help them figure out what's going on in their life. No, cuz it sometimes the most vexing problems can be rooted in the fact that one cannot sort out what is going on in one's own life. And we all have these problems problems every once in awhile. If Michael best hasn't found the same Sauk Centre Sinclair Lewis new and wrote about it could be that the town has changed in 50 years, but more likely the answer lies in the man and his experiences both personal and educational. after living in the city now for 5 years in 5 years the things that the little things really show up big when we first came here. We were the first night we slept here. We neither one of us could get to sleep cuz it was so quiet and we lived near the freeway famous cities and the rush of the freeway traffic and everything in in G. You just you come to appreciate though the seasons and the Just the scenery and everything that is really great. The people the generosity of the people in a small town is almost beyond belief in that. I'm sure that that my position has had something to do with it. But even going back to my Boyhood experiences in the similar type of town in Illinois, I can see you know, that people are quite generous and they're there. Lacking many of the suspicions that people in the cities have in it's really it's almost unbelievable how good people have been to us. Our family care in that is really Meet us quite fond of living in a smaller Community as well as other things, but the people anywhere you go. I think those people that you deal with her eventually turn out to be the most important things. I'm not putting down people in the city at all. But I think that in the hustle and bustle sometime you should do lose consideration for the next person. You don't know him. You've got nothing to lose or gain here. You may not know the person either but there seems to be more of a We're pouring generosity between people. excerpts from Lewis at Zenith A3 novel Omnibus published by Harcourt brace and World New York music from the album The Red Pony by Aaron Copland a Columbia Odyssey recording a sense of place was written and produced by Claudia daily for Minnesota educational radio under a grant from the Minnesota Humanities commission engineering by Glenn Owen.