 Oct. 15 - 16, 2002 |
| ASSEMBLY EDITION • SAN DIEGO |
Many rural physicians burn out and leave their rural communities. Darrell Carter, M.D., of Granite Falls, Minn., the 2003 AAFP Family Physician of the Year, knows it happens. But Carter found a way to avoid burnout -- he made learning to handle a range of medical emergencies his mission.
He also helped develop a system of teaching other rural health care professionals to care for critically ill and critically injured patients.
"On a given day, I'm probably going to have to take care of very sick patients who are having heart attacks, maybe a kid who has fallen and has a head injury," Carter says. Sometimes he'll deliver a baby who's in distress.
Carter, a physician with the Affiliated Community Medical Centers P.A. in Granite Falls, has practiced medicine in the town for 30 years. Many times during his first 20 years in practice, Carter says, he felt inadequate to perform emergency procedures on critically ill or critically injured patients.
On one occasion, for example, a newborn went into cardiac arrest shortly after the delivery. Carter performed prolonged resuscitation to get the baby's heart started again. But the newborn started seizing, and Carter thought the baby would die. The baby survived, as Carter puts it, "by a gift of God." The following Christmas, the baby's family gave Carter a plaque that reads, "Thanks for giving God a hand."
Carter says a series of similar "uncomfortable situations, where I felt inadequate," inspired him to learn more about emergency care. "One of the big driving forces was the feeling that I needed to do better," Carter says. "That's where the Comprehensive Advanced Life Support (program) was born." In 1993, Carter and a team of medical professionals started developing this emergency care training course for rural health care professionals. The team included family physicians, emergency physicians, nurses, physician assistants and paramedics.
A major part of creating CALS involved writing a 1,000-page manual containing didactic material and a list of skills considered essential for treating critically ill and injured patients.
In 1996, the course -- which includes home study, a two-day class and a one-day lab on procedural skills -- debuted. Since then, almost 1,000 medical professionals from various Minnesota communities have received the emergency care training.
Unlike physicians practicing in urban areas, rural FPs don't have an array of specialists to hand cases off to, Carter says. So emergency training is crucial for rural FPs and their teams. "It's become expected that the (emergency) service in rural areas should be the same as in urban areas," Carter says.
 "Family physicians can be so much a part of people, their lives, their families. And practicing in a rural community probably cements that in spades." -- Darrell Carter, M.D. |
Carter has helped train ambulance workers in Granite Falls and in neighboring communities. He's also chaired a physician advisory committee that has set up pre-hospital care standards for ambulances in the region. "These are not paramedic ambulances," Carter says. "These are volunteer ambulance squads, staffed by people who work at the hardware store and the gas station who've taken some basic EMT training."
In small towns such as Granite Falls (which had a population of 3,070 in 2000), ordinary folks have to pitch in.
Carter's care for patients, his promotion of emergency training for rural health care professionals and participation in developing CALS earned him the Minnesota AFP Family Physician of the Year Award in 2001 and Minnesota Rural Partners' 2001 Rural Health Hero Award. Carter will receive the AAFP 2003 Family Physician of the Year Award Wednesday, during the Assembly's opening ceremony.
However, Carter says his greatest accomplishment is helping his friends. Part of what he offers them is the empathy that comes from knowing what it's like to be seriously ill.
About five years ago, Carter was diagnosed with kidney cancer and ultimately had to have one of his kidneys, a ureter and part of his bladder removed. He's disease-free now but changed, he says.
"I think I understand an awful lot more what people are going through when they get bad news," Carter says. "There's no question that as I talk with patients and have to discuss some end-of-life or life-threatening issues, things are different. They (the patients) seem to know that I understand, and more than ever before, they really seek my input into what makes sense for them in terms of those life-and-death decisions."
As a small-town physician, however, Carter had a special bond with his patients even before his illness.
"Because I've been in the same place forever, these patients are friends. They're people I go to church with. They're people I see on the street," Carter says. "It's really rewarding to be able to help people through some of their life crises.
"Family physicians, in general, have that as a luxury that many other physicians don't. Family physicians can be so much a part of people, their lives, their families. And practicing in a community rural probably cements that in spades. People grow to depend on you and look to you for all kinds of help and all kinds of guidance. That's a very rewarding life."
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Copyright © 2002 by
American Academy of Family Physicians.