Tara Ness chose the University of Washington School of Medicine in part because its TRUST program would provide her longitudinal clinical experiences in rural areas. Though she was initially nervous to begin shadowing doctors and observing their interactions with patients, she soon learned that all the patients were rooting for her.
By Tara Ness
“I would have come in sooner for you to take a look at my ankle, Doc, but it was calving season, and I just couldn’t leave it all to my husband,” “Mrs. Smith” told the family doctor that I was shadowing. Mrs. Smith was a small-town ranching woman, tough, straightforward, and friendly. Throughout my month spent shadowing doctors in rural Lewistown, MT, during my second year of medical school, I met a number of patients that tugged at my heart strings because they were upfront and honest about who they were and were proud of it. The hospital drew from the surrounding areas where people grew grain, raised cattle, or wore traditional clothing and lived self-sufficiently in isolated religious colonies.
My preceptor left the room for a moment and Mrs. Smith and I began to chat about my time in Lewistown and my plans for the future. I told her that I was in medical school and wanted to work in primary care. And I told her how nervous I was and that I appreciated her allowing me in the room with my preceptor. “Of course,” she laughed, “You have to learn somehow! You’ll be a great doctor. All you have to do is get through all that book stuff first.”
Having grown up in the small town of Huson, MT, I applied for medical schools that would prepare me to practice in a rural area. I love small towns, stepping out my front door and into the woods, and the emphasis on the simpler things in life. I’m now in my second year of medical school at the University of Washington as part of a longitudinal program that helps prepare students for work with rural and underserved populations. The Montana TRUST (Targeted Rural and Underserved Track) program began in 2008 and aims to link students with communities to foster long-term relationships. Before medical school even started, I spent two weeks in my TRUST community and visited once a semester during my first year. I spent a month the summer of my second year, and I’ll return again my third year for about six months of clerkships in the town.
Although I’ve had the opportunity to observe many different specialties during my time in Lewistown, I gravitate toward the family practice office where I have more time to ask patients about their passions and discuss social issues in addition to whatever medical problems they might have. Each patient interaction I have is unique. The new, young mother who is happy to let me hold her baby, the little boy who bravely lets me help change his wound dressing, and the many expectant mothers that let me in on such an intimate part of their family’s life.
And then there was “Mr. Charles.” He recently stopped me in the hall of the clinic. At this point, I had only spent about two months total in Lewistown, and they had been spread out over a year. But he remembered that I was there during his son’s birth a few months earlier and wanted to show me pictures of how he was growing up. He beamed as we shared the small bond of both having been there for the first night of his son’s life.
I’ve always been drawn to primary care because of its emphasis on patients’ whole lives. It addresses the whole person and allows for the long-term relationships that help you understand a person in both their medical and social contexts. It’s one thing to identify a patient as non-compliant, but it’s another thing to be able to learn, in the context of their life’s demands and challenges, why they aren’t able to comply. I also enjoy the opportunity to teach patients and empower them with information about their own health. I appreciate having the time to listen to a patient about how they kept putting strain on a muscle injury because the fieldwork just had to get done or they didn’t take their medication because it was too expensive that month.
There are, of course, good days and bad days. There are days when you encounter patients who are emotionally draining or who, for whatever reason, won’t open up to you. There are also days when you’re exhausted and don’t feel like you have anything more to give to patients because you were up all night for a delivery or spent your whole lunch hour doing paperwork rather than relaxing.
But on those days, I remember interactions with patients like Mrs. Smith or Mr. Charles. These interactions are what bind me to the community and keep me coming back. In the end, the patients are just as much invested in me and helping me as a student as I am in helping them.
Tara Ness is a second-year medical student at the University of Washington School of Medicine, where she participates in the longitudinal clerkship program TRUST (Targeted Rural and Underserved Track). She is an active member of the National Rural Health Association and looks forward to future advocacy for rural health and primary care. In her free time, Tara enjoys hiking, traveling, and crafting with her husband, Jeremiah, who also participates in TRUST.
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