A Stone's Throw from Mayo Clinic and not an Ultrasound Tech in Sight

Figure: Mayo Clinic, emergency ultrasoundFigureI had a day and a half off between shifts, so I decided to take a road trip to nearby Rochester, MN, where the original Mayo Clinic mecca is. It's only an hour away from where I was working, and I couldn't pass up the opportunity. I come from a medical family, and I cannot remember a time where I didn't revere Mayo Clinic. My youngest sister lived in Rochester for about six years in the 1990s, so I contacted her to find out if she remembered anything about the city and what her favorite part was. She said her favorite part was “seeing it in her rearview mirror.” No help there. I was able to arrange a meeting with the director of the ED on their Saint Marys campus and a tour of the brand-new emergency department that was only two years old. The technology incorporated into their rooms and resuscitation and trauma bays was incredible and blew me away. The director and I agreed, however, that it was a great opportunity to have and train with this equipment, but it didn't really prepare residents to work in a limited-resource critical access hospital like where I work. You often have to MacGyver your way through difficult situations. I appreciated that thought, and it helped me feel more like a MacGyver superhero than a podunk hick from a small town in the inland Northwest. I pulled out my trusty TripAdvisor after touring the ED, and found that one of the top-rated restaurants in Rochester was across the street from the hospital. The Canadian Honker was fantastic, and the coconut cake was everything they say it is—believe the reviews. Not fancy or remotely upscale, just good. I walked close to a mile to the actual big Mayo Clinic downtown and got lost in the historical section. I made sure to bring my Mayo Clinic ID, and I had a Wayne's-World-backstage-at-the-Ozzy-Osbourne-concert moment. I flashed my badge and got into the library where only employees were allowed. I tried to play it cool, but I was fangirling embarrassingly the entire time. Walking out of the main building, I stumbled onto a street fair which apparently was there every Thursday during the summer. I wandered all around town and had an enjoyable afternoon. Sorry, sis, I thought Rochester was awesome. And I got pretty excited that I was part of the Mayo system. No Backup The shiny wore off when I got back to the small community hospital where I was practicing that week. Four 12-hour shifts a week was tiring. It is 48 hours in five days and in a busier place than I'm used to. The mental fatigue from trying to wrestle with a new electronic health system was starting to wear on me. That Sunday, I needed an emergency ultrasound to rule out a life-threatening condition. I asked the clerk to call in the ultrasound tech, and she checked her list and advised me that that patient's condition was not on their approved list and they couldn't call the ultrasound tech for that. I pleasantly replied that it was an emergent condition, and I would be happy to talk to the radiologist, department director, or whoever I needed to get this approved so we could get the study done. Suddenly I had staff bombarding me on all sides telling me that I needed to readjust my expectations. This was a small community hospital, and it simply couldn't be done. Nobody can out small-hospital me. I work in a six-bed ED in a critical access hospital that has a peak admission capacity of about 12 beds. I'm the only doctor for about 40 miles in any direction for the majority of my 24-hour shift. A few family physicians and a few midlevels are in town during weekday office hours, and there is a part-time family doctor who rounds at the hospital in the morning and evening. No surgeons, no OB coverage, no backup of any kind. Every emergency consultation means a transfer. This Minnesota place was rolling in resources compared with what I'm used to. There was no way they were playing that card. I pleasantly reminded them that standard of care does not change regardless of where you are. The only things that change are the resources that you're able to mobilize and how you are able to do what you need to do. I kept getting an earful of “That's not how we do it in Minnesota.” Eventually I talked directly to the tech and convinced her to come in. I got the study done. I took care of the patient and did not have to transfer her for the test. That's how I do it in Minnesota. You're welcome, Mayo. DR. HITCHCOCK is a residency-trained, board-certified emergency physician with more than 30 years of clinical experience, mostly in smaller hospitals, many of them critical access. She is the founder and current vice chair of the American Academy of Emergency Medicine Rural Emergency Medicine interest group and has credentialing and does work in palliative care. Share this article on X and Facebook. Access the links in EMN by reading this on our website: www.EM-News.com. Comments? Write to us at [email protected].

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