I live in a pretty small town; I also work in a pretty small town, however, there is a miles-wide socioeconomic gulf between both of these villages. My work town is an old mill-town; we will call it Milltown, for the purposes of fun and entertainment. It is on the lower end of the social order, a poorer town with all of the problems that one would expect. It is also the more interesting of the two, and I tend to spend more time there than in my own town.
I know many of the police officers as they are mandated to "check up" on us in the evening, being an establishment of mostly women. The majority of our docs are male, as is our Brazilian housekeeper, but our only security team is 911. We have video surveillance, but more on that another time.
I also know the EMT's and paramedics from Milltown, as well as surrounding towns. These are always good people to know. They are mostly hard working and care about the patients, as well as being mindful of our limitations in my small facility. For instance, most will not bring us cardiac, stroke, major trauma, head injury and the like for lack of CT scanner and other diagnostic tools or the ability to definitively care for them. The paramedics from my town are lazy, though, and at night they tend to bring inappropriate but stable patients to us. They know better than to bring alcohol intoxication and suicidal patients to us (although they do walk in) because we have no facility to watch them, keep them (and us) safe, or a social worker to arrange appropriate admission. Of course at night they do anyway; a couple of them, as I said, are lazy. There are exceptions that we gladly accept from any town EMS, though; they have had several "hot potato" cases and major trauma involving a child that have been brought to us because they are 1. without an airway or 2. so badly injured they need to be airlifted to the Big Time Hospital. Conveniently, the landing zone is our back yard. We don't panic, we are all well trained, or have spent time in trauma centers. We do the job we are trained to do despite the limitations to the best of our ability. In several of these worst case scenarios the patients have survived and done well. We all pat ourselves on the back for a positive outcome.
There are lots and lots of people that routinely use the Milltown Medical Hut and Boat Rental. Some have insurance; many do not. It will be interesting to see what the Obamessiah's health mandate will provide for all of us in the coming months.
