Survival tactics Mary T. Johnston, MD Revelstoke, BC Can J Rural Med 1997; 2 (1): 33 © 1997 Society of Rural Physicians of Canada How do we survive the "call" of rural medicine -- the long hours for less pay, the onerous on-calls, the lack of back-up, the challenge of getting a good education for our kids, the increased costs of household goods and the lack of privacy in a town where everyone knows everything? The difficulties are very real, attested to by the many doctors who fail at rural practice and flee to the city. This is a survival check-list, not of what we can negotiate with our hospitals or communities but of what we must work out within ourselves. These tactics have been honed during my 22 years of surviving, and often enjoying, rural medicine. Set priorities and stick to them. Mine are family, friends, practice, community and hospital (call) in that order. If your child is crying and "they" want you to see a patient who has had a backache for 3 weeks, your child has priority. If your friend's life is falling apart and "they" want you to inject an IVP, your friend gets your full attention. If you and your husband need to clear the air and "they" want you to go to yet another hospital meeting, you stay home and talk. Get lost! Take a day off each week and be unavailable. Develop outdoor activities that get you away from your practice and out of sight. My favourites are fishing, hiking, mountain biking, cross-country skiing, gardening and wood chopping. If you are really at your wit's end, hide! Unplug the phone, lock the doors and take a hot bath. Or go fishing. Escape completely. "Plan one vacation as you are returning from the other" were wise words from my father, who was a country doc for 30 years. Take your holidays and get away. There is no such thing as a holiday at home in rural medicine. I'm still waiting to see if there can be retirement. Act deaf when you go grocery shopping. Be vague and distracted if anyone is rude enough to interrupt you. When they ask about anyone, you know nothing! Eventually they will appreciate the fact that you don't talk about people. Family values. Encourage your family to like outdoor activities. They might like a rural area if they learn to rock climb, ski, canoe or mountain bike. Teach them to be independent, to shop, cook and do their own laundry. You haven't time to do it. Everyone must like to travel. Animals, trees, skies should be favourite topics of conversation. Encourage the love of quiet and solitude and the study of nature. Crowds are to be abhorred. The PHONE ! When you are not on call, you don't have to answer the phone if you are in the bath, having sex, nursing your baby or consoling your friend. If you are on call all the time, don't always answer it; "they" will find you if they need you. Thankfully, cellular phones don't work very well in the mountains or deep in the bush. You are not married to the phone, and you will not take it to the grave, although it may drive you there. ENJOY! Enjoy the deer in your backyard nibbling your tulips, the bears helping themselves to your apple tree, the snow glistening on the peaks when you are up at dawn delivering a baby, and friends to walk and talk with, who will even listen to you B&C (bitch and complain). Enjoy quiet moments alone in the garden with the blue jays or hiking a country road. Enjoy the pace of a small town and its lack of pretension. Enjoy the space and freedom and the 5 minutes it takes to get to work. Enjoy the salmon, the huckleberries and other goodwill delivered right to your door. Table of contents: Can J Rural Med vol 2 (1)