When I was older and about to retire, I moved to a medium sized town. The hospital had a family practice residency, but no medical school to back it up. It was a small time program and, from time to time, the hospital had difficulty filling all their residency slots. The family practice residence rotated through the psychiatric unit where I would teach them, the best I could, about psychiatric diagnosis and treatment. I enjoyed teaching them, but the residents were average doctors, not as smart, nor as driven as the residents I had at Duke when I taught there.
There was one exception—a young man who asked to do more than expected. “I would like to dictate the psychiatric admitting and discharge notes and I would like you to read them and tell me how I can improve,” he said. Then he wrote out his number and asked me to call him if I had any consults in the hospital. “I would like to see those patients first and then you can come by and see them and we can discuss the case and you can tell me how I did on my evaluations.” He did extra reading and kept up with the current literature. He was smart and eager. I quickly became impressed with the breadth and depth of his knowledge.
“Where did you get your training?” I asked.
“I went to Harvard as an undergraduate and Johns Hopkins for medical school,” he said.
“My gosh, what are you doing here? You could write your own ticket. You could get into any top notch family practice program.”
“When I finish my residency, I am going back to my home town in Alabama. I want to work in the rural areas. That’s where I grew up and where my folks live. That’s where doctors are needed the most. I figured if I was going to practice in a rural area, I should get my training in a smaller program. You practice medicine differently down here. You are practical. You are more interested in talking to patients and examining them, than you are in fancy diagnostic tests. When you hear hoof beats, you look for horses, not zebras. Stanford, Yale, Columbia—they are great programs, but I think I will learn more about being a real doctor here.”
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