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I just want to share with you some of the joys I have had
in my career. And a lot of those were spent
in rural family medicine. So before I get started,
it's always nice to know
you know, making sure I'm not associated with any,
rural medicine head hunters organization, or anything like
that. My bias is education.
And also, you should know that I am somewhat of a granola
tree-hugger.
So that's my bias. ( light laughter )
does it, and so we don't fray I ltoo far from that.ure
I also love being in nature.
to rural medicine at the beginning of my career.
So, let's talk about the
I'm going to talk about two loves of mine.
Actually, I'm not going to talk much about integrative medicine,
but about the versatility of family medicine, about having
an education in all aspects of human living and disease,
and creating a foundation of
process of what it means to heal, not only for the person,
but also the community. Because when you go into rural
medicine, you're not only a physician for a person,
you're also a physician for a community.
And that's a lot of fun.
at a place of importance You're automatically placed
You're actually seen as a community "healer," if you will.
But, let's look at a lot of different family docs.
You can pretty much do anything in the world that you want to do
after getting a good
in family medicine. David Satcher was the
Surgeon General, a family doc.
AMA president, was a family doc. Nancy Dickey, the fist woman
the creator of Sherlock Holmes was able to create Sir Arthuthosean Doyle,
good mysteries because of the understanding of his
generalist background.
in our medical school. Our deans here
Dean McBride, Dean Hawk, Our Dean Schocholac,
Rural Medicine, Global Health, Academics,
Preventative Cardiology.
this is a great foundation. But I would argue that the best
education I got were those first
in a little town in rural Idaho. five years in private practice
a little bit together. And we're going to explore that
in our healthcare system is Pthat we've gotten so darn good
at technology, we've forgotten
means to really understand about the aspects of what it
or an individual heals. And going out in rural medicine
is really a great opportunity to explore those foundations.
So, we want to do more than this, right?
You go through all these years
Four years of high school, of training.
four years of medical school, four years of internship
and residency,
You know, when I got out "Here take an aspirin."
to cure the world, you know. of my training, I wanted
I loved to fix stuff. I loved to fix it if you can.
But once you get out into private practice, you realize
that you fix it when you can, but most things that we see
in medicine now can't be fixed. And they have a deeper
underlying etiology that requires understanding of
the bio-psycho-social-spiritual influences of that individual.
So, this is a famous
on "The Country Doctor," of a doctor up in rural Colorado.
I thought I'd just start
country rural docs. I bet you would still see this
up in Northern Wisconsin. Here is a family doc.
I'm not sure why he had to
( laughter ) pack heat, but he did.
patients, I don't know. But the art of being a rural
doc, is sometimes you don't have access to the technology.
Sometimes you don't have access to the MRI or the CT scan.
We didn't.
the art of medicine to really understand what may influence
the body's ability to heal. If you don't have that
technology to rely on, you have to rely on you heart,
or your humanism. And sometimes just sitting down
with the patient
to help facilitate their belief in their ability to heal is
one of the most important tools.
one of the fathers of Medicine Sir William Osler,
to know what sort of patient said, "It is much more important
than what sort of disease a patient has."
And in rural medicine,
because you can't help this gets driven into you,
influences their health. but seeing how that community
I learned in rural medicine And this that you become thing
part of a community.
in that person's life Yobefore they come to youned
with reccurring headaches.
gives you insight that they're And being part of that community
that they have a story much more than a disease,
Every disease has a story. behind their disease.
gives you insight into that story, so you're better able
to help understand
Now, this is a great place how they can heal.
a tertiary care center. But how much medicine
or healthcare is provided in our tertiary care hospital?
Out of 1,000 patients,
is taken care of one percent, or 1 out of 1,000
most of our training. Most of healthcare is delivered
outside of the ivory tower
Most healthcare is provided tertiaout in communities.center.
And this is just a reminder of the importance of that.
Now, this is a Michelin Man at a very young age.
( laughter )
a family doc is that we get the opportunity to practice
womb-to-tomb medicine.
And we can sit and hold the hand We can deliver babies.
Everything from delivery, to newborn care, to pediatrics,
to adolescence, to geriatrics.
"how can you do all that?" People often ask me,
common sense, good support You know, with good
take care of almost 93% of what comes through your door
in rural medicine.
and you learn what you can't. You leaWhen you can't, handle,
you ask for help. So, the family physician
provides continuity of care,
regardless of age, sex, provideor diagnosis.ve care
We have no biases.
who comes through the door. You share trust, respect,
and friendship with patients. What a joy to be in a profession
where your friends pay you
You know? You can make a living
taking care of your friends.
you know, that's payment That's worth a lot of money,
We manage an individual's ototal health.f.
We understand multi-influential aspects of health,
the bio-psycho-social-spiritual uniqueness of the individual
that helps us best help them. And it is founded
in relationship-centered care.
insight into what that person Tmay need to be healthy.us
So, after I finished training,
for my undergrad. I went to Greeley, Colorado
for my residency training.
that really focused Aon training someone to go outam
into rural medicine.
of C-sections, and put in And so,chest tubesdo a lot
and manage acute MIs. And so, after my training,
I said, "Okay let's go out
And my wife and I, we opened up the atlas and we said
where do we want to live? And this is the nice thing
about this type of training,
anywhere on this planet iand go and be of service.k
We picked this place, Driggs, Idaho,
that is in this box.
is on that southwest corner of Yellowstone National Park.
This is where we lived. There is a little town here
called Victor.
Anybody ever been Over to Jackson, Wyoming?ming.
Good skiing and fishing.
to Driggs, Idaho? AnybodyOne!r been
Why were you there? Oh, Pocatello,
right down here.
So you know this place. It's grown a lot
since I left there. But when I was there,
we had a little 14-bed hospital.
We had a nurse practitioner and a physician's assistant.
And we had the best nursing staff in the world.
And we provided that womb-to-tomb medicine.
Now, when you're
you go into a community that a well-trained rural doc, and
you can really have a positive needs healthcare professionals,
of that community. influence on the health
a little bit more. Let's look at this
And it shows that a new doctor This was published in JAMA.
community in need provides tremendous benefit.
But once that place gets saturated with care,
a new doctor doesn't
But once there are actually provide benefit.
that healthcare system so many people providing health,
Now, we saw this can actually produce harm.
and Driggs, Idaho. in Jackson Hole, Wyoming,
a nice place to live, right? Jackson Hole, Wyoming, that's
all the outdoor stuff. Great skiing, you've got
physicians than hospital beds Worry in a town.s more
This town had more physicians than hospital beds.
They had a saturation of orthopedic surgeons.
And there was a big fight for ACL repairs in that town.
( light laughter )
the mountains skiing, and they would tear their ACL,
and boy you'd see all the fangs coming out.
And there was probably
that probably didn't need a lto get repaired.red
And there was so much access
that that technology to healthcare, the technology,
actually created more harm was probably overused and
So we have an opportunity to really go into areas
that can really enhance healthcare delivery
and really serve
But once we get to that the bensaturation point,munity.
our services
Sounds a little silly can actdoesn't it?re harm.
But it's true.
do you want to live? All right, where
It was a pretty cool place. ThisWe had our little town,ive.
Driggs, Idaho, right here.
great trout fishing. We had the Teton River,
were too smart for me. Although the fish
We had Grand Targhee Ski Resort, They wouldn't bite my fly.
Our house was right here which was up here.
And I had a snow machine in the foothills.
And we would play up here that wwith this view. here.
And that was the most gorgeous
Now, these are place on earth.
And this is the road the Teton Mountains.
And the nice thing up to our ski resort.
with a ski resort, is that you about being a small town doc
for that ski resort. get to be the medical director
And the medical director ( laughter )
And that medical director could bring a buddy.
for a buddy pass. And all we had to do
was carry a radio.
reduce the dislocated shoulder Sometimes, I get called down to
But the majority of time, it was great powder skiing.
And I had Tuesdays off. And I would usually
take Tuesdays off to go skiing
But then again, we had to work in the wintertime.
You know, being one of two doctors in a rural town,
is you're on call every other night.
But we had an excellent physician's assistant
and a nurse practitioner
So really, I only had to go in who were in that call schedule.
But we had good nurses, who also kind of triaged and
said, well, that earache
when the doctor is in clinic. can waSo the communityning,
takes care of you.
you're probably Theynot going to stay.out,
So the community has a sense
This was our valley, of taking care of their own.
And I'll bet it's grown a little bit since then.
And this was our
Now I'm going to tell you some pluses and minuses.
You should always have polarity in anything you talk about.
But there were a lot of pluses, and there were some minuses
to rural practice.
Freedom to do Onea lot of cool stuff thatom.
you were trained well to do.
I did ultrasounds. We did C-sections.
We had a surgeon that came over We dfrom Jackson to doals.
our more complicated surgery. So we had an opportunity to
do some of these procedures,
We had about and we did them well.
Eight percent, considering an 8% C-Section rate.
is now about 28%. So I delivered about 50 babies
a year. So that was about four
or five C-Sections a year.
My partner also did them, so we did just enough to
probably keep our skills going. I don't do them anymore, because
I have all my colleagues here who do a lot more than I do.
We provided a service there,
that were really beneficial to pfor that community.ures
We also had a lot of excitement.
is stress. And the polarity of that
to come through those ER doors. YouAnd you're the only one,ng
as well as your team. So the excitement was that--
This was a patient of mine. Let me tell you his story.
He was a good guy,
he had alcoholism. but he had bipolar depression;
for a number of years. He had been dry
I did his vasectomy. I delivered two of his kids.
had enough, because he had And one day, his wife had
a quality relationship. And he started drinking again.
His wife left him.
wife's house and he sat outside. And he got a gun and went to his
was meaning to commit suicide Morthrough the cops.k he
He had a gun in his car.
his wife's house. HeHe pointed the gunde
out the window, or he got out of his car
and he pointed the gun, and he got shot by our cops.
He came into our emergency room.
He looks up, "Dr. Rakel." Let's say "Bob."me is Bob.
This is continuity of care. ( laughter )
"Bob, I need to put a chest tube in you
and I need to intubate you."
And Bob survived. I'm not sure
his marriage survived.
in our hometown. But he may not still be
of continuity of care. But that was an example
I was able to talk to Bob and his family because I knew him.
This was a guy
He came in what that who came in with chest pain.
He was having an acute anterior MI.
You know what we call these?
Tombstone S-T elevation, That's right.
Unfortunately, or widow S-T elevation.
But whenever you see this that S-T elevationhere.
over the V-2 and V-3, that's right over the anterior
aspect of the heart.
is the AV Node is right over The reason that's so dangerous
And if you lose perfusion thatto the AV Node,art.
you lose electrical activity
So this is the most fatal type of MI you can have.
If you want a heart attack, where do you want it?
You want it inferiorly. If you're going to have
a heart attack, that's
that goes to the base usuallyof the heart. artery
There's not a lot of electrical stuff down there,
but you lose the pump.
you need to give fluids. So when you have an inferior MI,
of fluids, because they lose You need to give a liter
But that usually doesn't their cardiac output.
These kill you. He had re-perfusion arrhythmias,
because we gave him the thrombolitics and the Heparin.
And then the blood starts to re-perfuse the myocardium.
It can trigger an arrhythmia. We shocked him out of it.
We got him on the helicopter. He made it to Idaho Falls.
And he died three days later
because the MI weakened his anterior wall so much
it blew out.
He was 43 or 45. He had two kids.
his wife, who obviously went So, I was able to deal with
I knew why. inI got this off the Internet.s.
I thought it was funny. What's the diagnosis here?
( laughs )
with the cranial nerves! Something to do
of viral exanthum, right? Let's look at his diagnosis.
( laughter )
You see a lot of this stuff I'm sin rural medicine.out.
One of my most scary stories--
don't have to look at that. ( laughter ) so you
One of my scariest stories
was a boy a little older in little Driggs, Idaho,
and there was no history. His mom said she went into
his room and found him
coughing. He was beet red and was having
a hard time breathing.
Any time you see a kid That's all the history I got.
is beet red, you think of shydrocarbon poisoning.
You know, maybe he drank
or cleaning product. some sort of gasoline
with me. So I had a medical student
and get everything And I said, "Go to their house
So the medical student runs over there and pretty much
cleans out their whole house. He comes back and we're going
through each of those.
"Matt, did you take this?" We'll call him Matt.
"Did you take this?" He said, "No, no."
I was scared to death, "No, no."
to die on me, becaand I had no idea why.oing
None. And when you have a little
five-year-old who you think is going to die on you,
boy, that gets your heart rate. I went through.
And we're turning around, going through,
what could he have taken? And all of sudden in the back
we hear this--
and vomiting sounds ) He threw up something
in the emesis basin.
I've never gone from such fear And it was a little toy horse.
He had fallen asleep to such delight in my life.
He had swallowed it and it got stuck in his esophagus.
I always think of foreign bodies
And eventually, he got to the point where he vomited it out.
And boy, that was such a relief.
going to die on me. I tAll right.was
So, one of the negative parts is isolation.
You're kind of isolated out there.
You don't have this tertiary care medical center
to support you. But then again, you realize
what you can do.
common sense, good training, You can do a lot with
I think this is a positive and humanism.
Your friends are your patients. This is one of my buddies.
He had a bunch of wild mustangs that he trained.
And we'd ride his mustangs
to Union Falls, which is this gorgeous falls.
He developed
Now in a small town, you eosinophilic fasciitis.
autoimmune diseases might come after a significant
social stressor.
It was interesting, during that time, he developed
this autoimmune allergic
that went all through his body. eosiHe got better.itis
He's a good guy.
This is a good lesson, also, They're all good.
someone's story. the importance of hearing
on how not to label people. I got this phone call at 2:00am.
I was on call.
You've got to come in We've got and see it.in the ER.
I get out, 2:00am.
And there's Betty. I drive into the hospital.
back and forth on the stretcher. There's Betty rocking
critical judgment of this Mhuman being was,,
ah, it's a chronic painer.
But in a small town, you have really incentive to go
and listen to their story to understand what's going on,
because you don't want to have
go to the emergency room again. to getBut you also wantter and
to serve this person's needs. I sat down with her and she
told me a story that would make your head spin
in regards to abuse.
Once you listen to that story, And each disease has a story.
worse headaches than you, after you hear that story.
After that night, I started to
And that "chronic painer" that see her on a regular basis.
became one of my best friends. my judgment mind labeled her as,
She probably still has headaches We had a lot of fun together.
But they were much less and she needed much fewer medications,
and she required fewer visits to the emergency room.
When I left Idaho, she gave me
And that's Betty. tThis is a medical student from.
the University of Washington. He came and did a rotation
with me.
right there in Driggs, Idaho, that would train their guides
to take people fly fishing. And they had to train
their guides, so they used us to train.
We volunteered to go in the boat
and do all this stuff. and have them tie our flies
for the medical student. So that was a perk
which river that was. Meaning and purpose.
Another fun thing about being involved in your patient's lives
is you get to understand
and purpose. what gives their lives meaning
That's his real name. I'm going to use his real name,
because he's gone on ahead. Gizmo.
His claim to fame was he dated
Gizmo had Stage 4 heart disease. Shirley Temple in the Army.
such congestive heart failure, Stage 4 is when your heart gets
I had to have him on about five or six medications to improve
his cardiac output
But he would still get so he could walk.
this end of the room short of breath going from
But once a year, Gizmo to that end of the room.
to being our town's St. Nick, our town's Santa Claus.
And we'd have a holiday parade. And I would sit there on the
side of the road with my kids.
as good old St. Nick, Giwith his donkey up
and have a sack of toys over his shoulder.
He would walk from one end
to the other end of our town, much longer than this.
Not much. ( laughter )
With a smile on his face, but no shortness of breath at all.
I started to think, boy, this event that he looked forward to
once a year, trumped my medication by far.
You start to appreciate the importance of the human
condition.
out, the body can heal itself given the right opportunities.
We get a lot of rewards.
really appreciate you. Your patients
That old saying And if curing goes one way--em.
I love to cure if I can,
But healing goes both ways. When you get in that healing
relationship with your patients,
as they do. yAnd they give you stuff.
And I still have this hanging in my office.
This is, I'll call her Barbara. Barb was one of my favorite
patients. She would come and see me.
But I got a lot more
( laughter ) out of that visit than she did.
this healing presence. She just had
being in her presence. You know, you just felt good
complementary and alternative Shemedicine, so she gave medy
this salve that she made
she said would cure everything from a weed in the woods that
And she also made me from rheumatism to sepsis.
And huckleberries, boy, in the mountains of Idaho,
people put where their
in their will, because they don't want anybody to know.
Just them and the bears,
So when you got this as a gift, you savored it.
Am I right? Have you ever gotten
huckleberry?
It tastes so great. Now, another patient, similar
to her, who also had
She was an artist. a very fascinating hobby.
things and go across Idaho And she would paint various
at arts and crafts fairs. And when I left Idaho,
she gave both me and my wife
And I was going ato show you that..
It's quite unique.
was about 82 years old. This is what she sold
at her arts and crafts fairs. ( laughter )
It has no meaning whatsoever! But that 82-year-old woman would
go around and make a killing
on her face. with the biggest smile
makes people happy, you know, Wthat was probably her besty
medicine, was going across
this at arts and crafts fairs. this state of ours and selling
satisfaction of rural medicine. SRelationship-centered care.t
Having your friends as your patients is a joy.
Clinical autonomy.
People come to you You get a sense of control.
And you're the first person that they see, so you have
all these diagnostic dilemmas,
Here, if I had to pick therapeutic challenges.
most happy with, I wouldn't practice here in Madison.
I would go back there in an instant.
I like being here,
But if I had to practice because I like to teach.
to rural medicine, because somewhere, I'd go back
Here, you know, I ca patient comes in.aft.
You know, you don't need
my diabetes doctor for that. to deal with that, I go to
I'm your diabetes doctor! What are you going to that one
over there for?!
where, oh, I've got a specialist It's almost gotten to a point
on my left foot. for the fifth toe
Oh, thank God. ( laughter )
has gotten so specialized that we're starting to know
more and more about less and less.
And when we do that,
and lose the larger whole. we start to see the finite
of rural medicine. That's the beauty
but see the larger whole. Whoops, did I go over
all the other ones? Providing care to everybody.
Everybody who needs care, you're there for them.
And life in small communities.
because they adopt you. Least satisfied.
Access to urban amenities.
My wife likes to shop at malls. And we were able to pay off
our debt quickly. ( laughter )
It was 70 miles to the closest mall.
Available time
This is a challenge. away from medical practice.
where you lived. You know, people knew
"Doc, he's just not You'breathing right, couldoor,
you take a look at junior?" "Yeah, I will."
But you'd have to leave town
We'd go to Hideout Falls, get a room at a hotel with a pool
in February for our vacation, for our time away.
Because that was nice,
I had a hard time going to our liquor store
to buy a six-pack of beer,
boozing it up. because you know, "Dr. Rakel's
( laughter ) Isn't he delivering your baby?"
you go buy me some beer?" ( laughter ) "Would
So that's a little
Let's look bit of a challenge as well.
of our healthcare system. I want to save some time
at the end for questions. But we've got a really
dysfunctional healthcare system in America.
We've gotten really good
haven't really done a good job at treating disease, but we
We're trying to take at facilitating health.
acute, catastrophic care. If you have an acute illness
that needs immediate help by the experts in the world,
this is the place for you.
that success and push it But we've tried to take
where there's disease oriented-- into primary care
of chronic disease care, There's this epidemic
the same tools for acute that we're trying to use
to treat the chronic disease, it doesn't work.
So we have the most expensive healthcare system
on this planet, $2 trillion.
They're 47% cheaper. Number two is Switzerland.
our quality that we provide, When you look at
We're number 12, rated for all we're number 12.
We're not really getting the industrialized countries.
Why is that? our money's worth.
this XYZ model. The X is we have a healthcare
system where you come in. I give you a diagnosis X.
That leads to a treatment Y that I get reimbursed Z.
An XYZ model. Diagnosis, disease focused,
treatment of the disease, reimbursement.
The disease gets reimbursed.
by our economic system, Thatis the disease.nored
That leads to fragmentation of the human condition.
Hypertension, obesity.
generalist family doc, If you're a good primary care
you're going to realize that rural doc,
have something in common. That if we just treat one
without the whole underlying
not serve the patient well, and we're going to fragmento
their care. So this might lead to certain
drugs SSRI for the depression,
and that's what gets rewarded. PPI for the GERD,
is through this process. That's how we get paid,
this healthcare system do? What does
the human condition. It fragments
into segments. It breaks the human body
to see the person as diabetic, And pretty soon, we're starting
instead of Betty, John and Joe. orWe start to label themd,
as a disease, instead of
and John need to be healthy. understanding what Joe, Betty
will reduce mortality the most Forty percent of what
is human behavior. in this country
on mortality. ThaIf everybody has accesstion
to our technology,
Human behavior changes through that reduces mortality by 10%.
So this is sometimes how I feel relin our current model.re.
I'm asked to see more and more patients,
with fewer amounts of time. And if I have less time with
someone, what am I going to do
Take this medicine. that'Or, let's do an MRI.ture?
I can be with a patient for 20 minutes
and day dream the whole time. They're telling me about
the chaos in their life.
to a word they say. But at the end if I say, okay,
let's do an MRI and put you on this medicine, they're
going to see that as worthy.
by our medical culture. BecWhen you're out in ruralted
medicine, you realize how dysfunctional that is.
And you start to feel like this guy.
You know, you start to realize
helping people. You know, they don't need
my drugs. They need my humanism.
A lot of times, they need both. They need my drugs
and they need my humanism.
Or they need my manual therapy
they need the MRI, too. So what we're trying to do
is create a healthcare model, not a disease care model.
The healthcare team is going to be different
than the disease care team. A disease care team, I'd have
surgeon, a dialysis tech, an internist.
The healthcare team might have
physiologist, a na health psychologist,se
a primary care doc. That team is going to be
much different than the disease-oriented team.
Both are important. I like doing both.
I like to fix it when I can.
So, if you can be I like a healing fixer,I can.
that's what rural medicine
So if we create this health focused care that is based on
relationship that gives us
really needs, we provide access, insight on what the patient
need, the most expensive we address all these areas of
Now if we can do that, interventions will go away.
But unfortunately, we show cost savings.
healing doesn't pay. in our current model,
So it's really hard to change that model, but we're trying.
We're trying to do it.
setting does that by default. They can't do anything but that.
Primary care
human relationships, based on relationships,
This is all in excellent improves quality of care.
Improves quality of care, reduces hospital admissions,
reduces expenditures on diagnostic testing,
lowers healthcare costs.
what are some industries Now if we look around town here,
and building new buildings? Business school, that's good.
( laughter )
Hospitals. That's one.
on every corner, or what? Is thereYeah?lgreen's
I like to look at communities and see what businesses
are flourishing.
are we getting In our community, Walgreen's,
Maybe so. a littlNew hospitals. drugs?
Dean. New hospital.
Disease is paying well. It pays well.
What if we had a healthcare system that first and foremost
focused on health?
the creation of health. Other than pathogenesis,
the creation of disease and suffering.
Most of your training is in pathogenesis.
Why does disease
But what if we switched your and suffering occur?
How can we understand trhow to create health.is?
If we first start there,
as many of these hospitals maybe we won't need
They're all important. to treat disease.
here with a few slides All right, I'm going to end
That if we just study the parts, of the importance of the whole.
or just the blood tests, if we just look at the liver,
of the color red, can we understand what's wrong
with that whole person? I would argue no.
That you need someone to understand what's going on
beyond their physical, that also brings in their emotional
and their spiritual.
than the sum of its parts. The whole is much greater
together, you get an impression Anof something much morets
beautiful.
a feeling, right? That's what changes human
behavior, is your ability to touch the patients' feelings.
That's why rural medicine is so rewarding for me.
They invited me into their lives.
I could do nothing but
insight into their emotions. touch their feelings, or have
their body's ability to heal. That So this is my Monetuenced
painting right here.
Guess how old she is. GWas, this was ten years ago,
or so.
Really? 91? ( laughter )?
She was 85. I thought she looked
like she was 60.
She was robbing the cradle. But you know, they weren't
health nuts, but they were
I've ever met. some of the healthiest patients
They lived in a community that supported them.
and gave them love. And they were vibrant in health
at this stage of the game.
the foundations of healing So when we understand
there are some key rules. We develop rapport and trust.
We develop insight. We develop an understanding
of the patient's beliefs. We read their emotions.
We're a good listener.
and one mouth to be used in that proportion.
And we're there with intention and compassion.
So cure sometimes, heal often,
And Rachel taught me this. support always.
a little bit. You're not going to make as much
money going into rural
on what's that ROAD family mto success.you would
Radiology, Ophthalmology, Anesthesia and Dermatology.
You're not going to make as much
But I would argue that money as those fields.
in what you receive emotionally. it will far make up for it
to create a positive influence That when you're really able
that needs you a lot, you get rewards beyond the monetary,
beyond the physical.
means that you're broken. If I'm going to fix you,
I'm assuming you're broken. And all of the human condition
isn't broke.
But helping suggests that, Helping is a little bit better.
going to get in return? I help you, what are you
going to do for me? But serving.
Serving means that I'm there
Because when I serve you, tI serve me..
Boy, that feels good. Service means that you're doing
good work that fills your heart,
the world a little bit better when we leave this life.
So these are the good days. You come out of that room
and you know you made a connection up there
in rural Wyoming
and you know a shift occurred. or rural Wisconsin,
And you come in that room and you know that this is why
I went into this field. Those are the good days.
And it doesn't happen every day,
and it makes you remember. but it happens
in everything. But there's polarity
when they're not so good, Theand your patientsays
make you feel like this.
But you know what? ( laughter )
But you go back the next day That happens.
a little bit better. and you try to do it
You don't beat yourself up. You go back the next day and you
try and do it a little better.
you're trying to do your best. They'll forgive you if they know
medicine fellowship, So when I went into integrated
are starting to use these other things, like acupuncture
and homeopathy. I want to learn
more about those. And so I thought I could go
and learn.
doesn't work, Okmaybe it's one of theseal
other complementary therapies that's the magic bullet.
And I found that the magic
But there's one thing bullthat always works.her.
One thing always works in facilitating health and healing.
And that's compassion.
with a root word, to suffer. Compassion comes
is where that compassion Two people suffering together
Mother Teresa said, "If you have comes from.
be there. a sMaybe just to hold a hand,me,
maybe just to give a smile, that is the greatest,
most beautiful work." All right, how many of you
feel like this donkey?
I know. ( I've been there.
I teeter over there quite often.
if we let our life get there, the first things to go with our
ability to facilitate healing are those most important things
that facilitate healing:
patience, empathy. compassion, ability to listen,
in healing The most important things
when our life gets are the first things to go
I like to use my dog a little out of balance.
You know, I come home, as my biofeedback device.
My dog comes over and gives me I sit down and I'm tired.
That's good for me. Hopefully, it's good for my dog.
But if I come home
and I'm upset and I'and I'm uptight.anced,
I'm mad at my patient who won't do what I tell him to do.
I come home, I sit down and my dog goes
to the other end of the house.
It's not my dog's fault. And I learned from that.
And I've got to look inward I'mto understand, okay, Dave,s.
am I getting out of balance?
getting a little heavy? It's my job to use that time
or that learning moment to step back and say, yeah,
I need to spend more time with my kids.
Or I need to go for a run.
hopefully will come down And then that teeter totter
Rumi said, "Let the beauty we and welove be what we do.e load.
There are hundreds of ways
In rural medicine, there are to kneel and kiss the ground."
to kneel and kiss the ground, a la lot of rewards.ays
All right.
from a hero's mind, the oldest I'm going to end with a quote
She died at 122. documented living human being.
And they asked, at 121, what do you attribute
your longevity to.
She said good red wine, She saolive oil,hings.
and a good sense of humor.
as saying, "I have only one wrinkle and I'm sitting on it."
( laughter )
we look at life, right? That's true in rural medicine.
It can be one of the most rewarding things you do.
And if I was going to go really learn about being a doctor,
really being a doctor,
to rural medicine, because I would go right back
that's where I learned the most.