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About Textbook Of Rural Medicine
Product Description Written by four members of the Department of Family Medicine at the University of Washington School of Medicine, a leader in rural health care. Focuses on special clinical problems and approaches common to rural care, augmented by practical information on management and organization issues, as well as rural and family medicine education. From The New England Journal of Medicine Twenty percent of Americans live outside metropolitan areas in what is collectively called rural America. But rural America is no more homogeneous than the metropolitan areas of Manhattan, Kansas, and Manhattan, New York. Rural America can be distinguished by its lower population density, smaller numbers of services, and fewer kinds of services, but not by a lack of diversity in terms of culture and ethnic backgrounds and the aspirations of its inhabitants. A textbook of rural medicine must reflect that diversity while assessing and describing the health and health care of 51 million people. The editors approach this task with the combined wisdom of three men who have practiced, taught, and researched rural health care for many years. They call on colleagues from academic centers around the country to expand on an eclectic group of topics designed to profile useful strategies that improve the quality of rural health care. The editors state that their intended audience is rural clinicians, clinician teachers, residents, medical students, other health professionals interested in rural health care, health services researchers, and others interested in rural health policy. To address this broad group on a topic so diverse is a huge, if not impossible, task. The authors make a valiant but not altogether successful attempt. The first section of the book describes the rural environment, the rural patient, the rural physician, the rural health care team, and the emergence of a federal policy on rural health. The picture seems skewed and harsh and appears to reflect years of personal frustration on the part of the authors. The statistics that health care researchers and policy pundits like to have at their fingertips are there, but the value of these facts to practitioners and students is less clear. The introductory section does give a fascinating view of the evolution of American health care and its effect on rural health care. As described here, the growth of medical specialization and subspecialization changed the focus of medical care and education from care by generalists to the treatment and cure of individual illnesses; the prevalence of rural poverty and the explosion in the number of women in medicine decreased the pool of primary care physicians willing to choose rural practice; and the rapid growth in the number of midlevel practitioners, most of whom stay in urban and suburban settings, has not stemmed the flow of clinicians away from rural practice. This summary of rural practice seems unlikely to inspire young clinicians to rush to embrace the challenge. But just when all hope seems to be gone, Rosenthal's chapter on the rural health care team reminds those of us who have practiced rural medicine why we did so. The ability to apply the principles of population-based medicine and public health to daily practice and to solve a medical problem by calling on the resources and resourcefulness of an entire community without task forces, seed money, committee meetings, and planning grants is exciting and satisfying to all involved. This explanation is what might make a student interested in rural medicine. A few medical problems are singled out for special attention. The selection seems arbitrary, leaving out preventive care, the care of heart disease, and the treatment of occupational injuries. Some chapters in this section move beyond the usual textbook discussions. For example, the author of the chapter on mental health flatly states that ``country people are different than city people.'' It is this ability to incorpor
