A Day in the Life of a Village Physician

Today I spent my time with Dr Albers who is one of the General Practitioners for Vorden, his wife Esther is the other. I walked into the brightly lit waiting room and was introduced to the staff that consisted of two secretaries and an assistant whose role is diabetes manager. The room where he performs patient exams doubles as his office and at this point I was really curious to see how the consultations play out in rural Holland. He briefly outlined the complaint of our first visit as tendonitis in the upper groin area in which he prescribed anti-inflammatories for two weeks prior. He guessed she was back for a visit because it wasn't going well. He retrieved her from the waiting area and explained my presence. A women in her early 60's firmly shook my hand t introduce herself and sat in one of the chairs next to his desk. They then had a discussion, in Dutch, about her complaint. I could follow the conversation somewhat but was kind of surprised when she stood up and took her pants off, with no qualms whatsoever, and pointed to the exact area that hurt. He asked her to lay on the table and started to palpate her upper, inner thigh - with no gloves on - to assess it properly. The pain was along her femoral artery and he was worried that it might be an abdominal hernia so he referred her for an ultrasound at the hospital, typed a brief note about the visit and we were ready for the next patient.

They do not employ a nurse or medical assistant that escorts the patient to a room, obtains height, weight and vitals and reviews medication lists, allergies, medical history, etc. The visit is only focused on the complaint and the physician types his note, writes prescriptions and referrals and fills out the lab envelopes himself all within approximately 10 minutes. The next two hours mimic the first appointment except for the emergency visit in which a 73 yr old man fell 2.5 meters (about 8 feet) off of a ladder and secured a gaping 20 cm cut that was bleeding profusely on his right, lateral lower calf (his lower leg, not his livestock). Dr Albers cleaned the wound and placed stitches on the ends and right in the middle leaving the rest open because it was a very dirty cut and he wanted the 'dirt' to work its way out and lower the chance of infection. He prescribed Doxy and sent him on is way with a follow up next week.

After lunch he performed a minor surgery - removing skin tags with possible melanoma - and then I accompanied him on his home visits. This is his favorite part of the day - driving out to the country and visiting patients in their homes. He believes it is better than seeing them in his office. He explained how people are more open and that family members can help by remembering things the patient forgot or giving their point of view on the situation. Everyone was very welcoming to me and one of them even spoke in English so I could understand even though she wasn't completely confident about it.

One of the beautiful farm houses we visited was the widower of the nephew of the famous artist MC Escher. She even had the original "Day and Night" piece hanging in her living area. She told me a story about how Mick Jagger called Mr Escher to ask if he could use his artwork for an album cover and the artist told him "No." Very cool!!

To end my day, we attended a palliative care meeting with a consultation group in which Dr Albers and Mariet (my host) are members. They recieve calls from nurses and other physicians for advice on euthenasia and terminal sedation. These are two different kinds of care and both are legal here with certain requirements. Terminal sedation can be used when a patient's life expectancy is less than one week and all other treatment options have been exhausted. They use midazolam and a high dose narcotic, usually morphine. This group reviews cases that have been consulted on and discuss the outcome to see how they can make the process more efficient and make sure it's within the laws.

I know this entry if very long, but I had an amazing day and wanted to share! Tomorrow I'm back in the pharmacy reviewing the medication lists of patients in the nursing home and finish inputting new insurance formularies for the month of July - yes they change monthly. Now, I'm off to water the plants and flowers with Annelie and practice my Dutch. Doei!!