ARTHUR — Drs. Sherry Williams and Kenneth Brown enjoy practicing medicine in the small community of Arthur. Both family physicians sought out jobs close to home in proximity and mind-set.
Williams, whose clinic is affiliated with Decatur Memorial Hospital, grew up in Bethany and lives in Sullivan. Brown, whose clinic is affiliated with St. Mary’s Hospital, grew up in Arthur.
“I’m a local girl,” Williams said.
Rural health care offers special challenges and rewards, the doctors said. Practicing in Arthur offers the opportunity to care for an array of patients, ranging from city dwellers to the area’s Amish community.
Williams’ clinic, Arthur Medical Center, is open five days a week and usually sees 17 to 25 patients each day.
“You never know what your day is going to be like out here,” said Williams, who that day had cared for a young man who was kicked in the chest by a horse.
Brown and Williams said they find themselves calling on aspects of their physician training that an average family doctor might not use on a daily basis. The cases involved, they said, might wind up in the emergency room in a bigger city.
Williams said she sometimes finds herself dealing with facial and other wounds that she might refer in a different situation.
“I’ll repair it, because I know the truth is, they’re not going to make the trip in to the city,” she said, referring to some patients for whom transportation is an issue.
It’s better, she said, than the patients trying to doctor themselves.
“We try to be as accommodating as we can,” she said.
It’s also crucial, Brown said, for rural doctors to have a good relationship with the local EMS crews that will be called upon to get patients to the hospitals quickly in emergency situations.
“Believe me, I consider myself very lucky to have them around,” he said of local responders.
People sometimes arrive in their offices with heart attacks or strokes, not knowing what to do, and they’re sent on to the hospitals as quickly as possible, Brown said.
The doctors said some rural patients differ from their urban counterparts in their needs and culture. On average, rural residents in the United States tend to be poorer and are less likely to have health insurance or coverage by Medicaid benefits, according to the National Rural Health Association.
A 2009 U.S. Department of Agriculture report found that those who live in rural areas have higher rates of chronic disease and other issues than those in urban areas, with a lower socioeconomic status and several lifestyle factors serving as contributing issues.
Williams and Brown said their practices do tend to see higher rates of chronic conditions such as diabetes, hypertension and chronic obstructive pulmonary disease than might be expected in more urban doctors’ offices, and many patients first seek medical care when these conditions are in a more advanced state.
Preventive medicine and health education do not always get the emphasis they should in rural communities, said Williams. Some people operate with the mind-set that a trip to the doctor isn’t warranted unless there is some kind of emergency, she said.
“I think, culturally, you’re kind of taught that,” Williams said, adding that in addition to helping to facilitate healing, her tasks also include teaching and fostering disease prevention and health maintenance.
Access to subspecialties or other medical services also can present obstacles to care in rural areas, Williams said, using her diabetic patients as an example.
“Giving them access to a diabetic nurse educator or a dietitian who can really sit down with them and have a lot more time to do more teaching than I would have” is a little more difficult than just sending someone across town, she said. “ … Having a distance to drive is sometimes just one more reason to put things off.”
For many rural residents, asking them to drive an hour or 45 minutes for additional care is a lot, Williams said.
The local hospitals work with their rural physicians’ offices to provide access to certain health screening tests and medical specialties by having them travel to the communities. Rural physicians often rely on the assistance and outreach of their county health departments and the use of technology to communicate and collaborate with other offices.
With four physicians practicing in Arthur proper, DMH, Hospital Sisters Health System and Sarah Bush Lincoln Health Center are among the health care entities represented.
“There are a lot of communities that don’t have any (doctors),” said Brown.
According to the National Rural Health Association, 25 percent of Americans live in rural areas, but only about 10 percent of physicians choose to practice there.
“I like the rural environment,” Brown said, noting that rural doctors have the unique opportunity to really get to know their patients, sometimes caring for a few generations.
Overall, there is a shortage of family physicians in the United States, especially in rural areas, Brown said. “I think some people think that the money is not there, so they want to practice in big cities.”
He urged students interested in pursuing medicine as a career to investigate the assistance programs for medical students who pledge to practice in rural areas.
The work is rewarding in fundamental ways, the doctors said.
Small-town physicians also have the opportunity to become community leaders, said Williams, citing a desire to get more involved in the community she serves.
“I still like to be involved in the community, and I certainly am,” said Brown, who serves as a sideline physician for the local high school football team.
Serving Amish patients is a unique experience, but it’s not all that different in the grand scheme of care, the doctors said. All patients want to be respected for their personal beliefs and needs, and one responsibility of a physician is to figure out how to best provide care without compromising those beliefs, they said.
“Sometimes we just have to understand that patients are where they’re at,” said Williams.
Working within patients’ personal limitations and guidelines to provide the care they need comes through proper communication and respect, the doctors said.
Brown said he enjoys when patients are savvy about their health care and ask a lot of questions.
“I like that,” he said. “It’s part of what I enjoy about medicine.”