Editorial Comment: Surgery in Rural America

Excerpt

If you want to get an accurate glimpse of rural American surgery less than 100 years ago you have to read a classic called The Horse and Buggy Doctor1 by Arthur Hertzler.2 Hertzler developed his thriving rural surgical practice at a time when “it was generally accepted opinion...that drunken doctors were very capable if sober.”1 Hertzler was born in West Point, Iowa, just a few miles north of Keokuk (now my home) and practiced in nearby Missouri. A year ago, when I moved to Keokuk from New York, I re-read Hertzler’s book. So much in the rural Midwest, and the pattern of its medical practice, have changed over the years, and so much remains the same. Instead of a horse and buggy, I ride a pickup F-150, but each morning I am welcomed by the cornfields and the great river, and at lunch time—between office hours and OR cases—I can catch a few fish in the Mississippi or one of the many ponds. I can confirm all the advantages of rural life and practice listed by our CEO Al Zastrow; and to his list I add a welcoming community, trusting patients, a modern hospital, and excellent quality of care. Of course, referral skirmishes and medical politics are not unique to big towns, but they somehow appear more benign in the country. …