One of the biggest lessons I've learned in traveling throughout Emergistan is the remarkable differences in what hospitals can do. There's a certain perception on America that every hospital can do what any other hospital can do.
I once had a young man come to me in my original job, stating he had moved to rural SC and needed a local doctor to manage his late-stage AIDS. He seemed surprised when I told him he would have to be seen in the next town. But that's life in medicine.
Small hospitals serve a great role, but they can't do it all. And big hospitals can do amazing things, but simply can't see everyone for all of the very real but relatively mundane problems that they have.
But to illustrate the point, I recently had to transfer patients out of Tiny Rural Hospital for: spinal fluid analysis, which my facility couldn't do. An eye evaluation because we lacked a slit-lamp. For an ICU bed because we lack ventilator capacity. And for a pelvic ultrasound in a woman to rule out ectopic, because we could only do males.
Of course, I could still identify the problem and stabilize. Start lines, get labs, intubate, etc. But medicine in 'the sticks' or in the poorer areas of large cities, isn't the same as it is in the large teaching centers. And that's probably OK.
It takes all kinds in Emergistan!
Semper A Decem, brothers and sisters!
