In the 1984 rock mockumentary This is Spinal Tap, a fictional band discusses the controversy surrounding one of their album covers. “There’s such a fine line between stupid and …” the lead singer says, realizing where they’d crossed the line of tastefulness.
His guitarist finishes his thought, “… and clever,” he says. In life, in rock and roll and in medicine, there is indeed a fine line between stupid and clever.
During my first month of practice, I was at the head of the bed in a rural ER, as Dr. Marcus Fredo stood a few steps away with his phone to his ear as he waited to speak to a trauma surgeon. The patient, a victim of a high-speed rollover, had a closed head injury and needed to get to a neurosurgeon. Stat. In trauma, doctors in rural centers have to treat patients thoroughly, while also recognizing their own limitations. Rural docs have to use clinical skill to quickly decide if, where and how patients will be transferred out to larger centers. Their patients need resuscitation and stabilization, but time can’t be wasted if their needs exceed the resources at hand. Conversely, rural doctors can’t just ship out every patient that looks sick.
Differentiating those that need urgent transfer from those who don’t is one of the many great challenges that rural physicians face.
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