Ode to a Primary Care Idol

Long Horns are crazy! This guy was on my way home from the clinic.

I started another semester of nurse practitioner residency in a rural Tennessee clinic. As a family nurse practitioner student I am allowed to train with doctors, nurse practitioners (NPs), or physician assistants (PAs), so long as they practice in primary care. Over the last two years I have come to know and admire a physician assistant in one of the rural health clinics where I've put in some time. We'll call her Molly Ann. I don't remember if I've mentioned her before but I also refer to her as my primary care idol. I want to do primary care like she does when I grow up. 

Why? 

Molly Ann is incredibly compassionate, a generous teacher, and most of all, brilliant. She's also extremely "country**" which adds a layer of entertainment to my training. Molly Ann never talks down to patients. She always breaks things down so they can understand, and she doesn't push her recommendations on anybody. When someone has been taking their medicine and has a good blood pressure reading during their visit, Molly Ann says "thank you for taking such good care of yourself", and she's not being sarcastic. Last week a patient came in and they were hungry and out of food. Molly Ann went to the grocery store and dropped off some food at the patient's house on her lunch break. When Molly Ann's nephew was born addicted to drugs with no mom or dad and sight, she took him in and called him her own. Molly Ann is legit. She skips the preach part and just does. 

Don't go thinking Molly Ann is some kind of stuffy righteous nun based on what I've just said. She also has a great sense of humor and is goofy as anyone I've met. One of my favorite funny kid stories comes from Molly Ann. She has two young boys and one day one of them said "momma, what does sexy mean"? Before she could respond her older son replied to the younger, "it means fancy!".


To fully understand why I think Molly Ann is so clever I need to lay a little background info down. In rural primary care patients often avoid the doctor, local hospitals, and god forbid they be forced to go to "the city". Patients may or may not have insurance, and even if they are insured, prescribing a four dollar medicine may be a lot to ask of their budget. What I'm getting at is that to practice rural Tennessee medicine you need to know of to treat patients on a budget which is a whole set of skills on their own.

The lady at the front desk of your doctor's office is not necessarily a medical person. When you call to make an appointment they have to list a reason for the visit. This phenomenon makes for some pretty hilarious lists as exhibited by the one above. 

You also need to be able to diagnose your patients with limited resources. Your patients may be unwilling or unable to get an x-ray or go to the city to see a neurologist for example. As a result, your physical assessment skills have to be top-notch. With the abundance of technology and resources the 21st century provides, not all doctors, NPs, and PAs rely on the old-fashioned toolbox of physical assessment skills. To me, on-point physical assessment skills are the definition of badassery in primary care. And yes, Molly Ann has a mean toolbox. If you are interested, the first two paragraphs of this guy's essay describe the physical exam debate pretty well. 

When I'm a real nurse practitioner I'm sure I'll put my own spin on things. Molly Ann has taught me to slow down and be present with people, but I'll never be as kind and patient as she is. We have similar beliefs and interests but she and I are cut from different cultural cloths. In the meantime, she inspires me to continue on with my goals and put my best self forward.


*Note to Northerners and city folk: "country" refers to a person who is both rural and southern. Not all southerners have accents or are from rural areas. Expect a post on some country folks soon.