By David Janssen, MD
Have you ever played Dutch bingo? Despite the name, no numbers or cards are required. When two people of Dutch descent meet one another, “Dutch bingo” describes the typical practice of naming relatives and friends until they find a way to connect themselves. Having grown up in heavily Dutch Sioux County, I used to be an expert at this game, but I forgot many of the connections after moving away for over a decade. This past summer, I said goodbye to Davenport, Iowa and returned home to practice small town medicine in Sioux Center.
To survive a career in medicine, an important life skill is compartmentalization, leaving certain aspects of the job at the hospital or clinic. Burnout comes too quickly to the physician who constantly carries the weight of the job. My partners and I cover the emergency department, clinic, hospital, and labor and delivery. We see patients at the high and low points of their lives.
Rural family medicine means that those patients are neighbors, church members, friends, co-workers, and sometimes even family.
People often say that “there are no secrets in a small town,” and I worry that sometimes my patients think that adage extends to medicine as well. I find myself frequently reminding my patients that our visit is confidential and calling people myself with their lab results to shrink the circle of trust. Hippocrates wrote that we are to hold these things as “holy secrets.” Perhaps privacy and confidentiality in medicine are even more important in a small town, where it seems like nothing else stays secret for long.
I love that I know my patients so personally. I enjoy when patients approach me at restaurants or at community events to say hi and show me how much better their child is doing. Sometimes I am almost overwhelmed when someone I have known since childhood comes to me to establish care or trusts me to care for them and their unborn child. Since moving back, I have quickly learned to ask patients for permission to say hi from them to my siblings or parents, as I suspect they assume I would be extending greetings anyway. The nuances of HIPAA are not fresh on the minds of the average civilian.
Frequently this results in awkward encounters at parties and events where I professionally know several people in the room but cannot acknowledge this unless they do. The “Iowa nice” boy in me does not want to seem standoffish or rude, so it is always a relief when the patient-turned-social-acquaintance walks up and says hello. I think that it often does not occur to adults that I am guarding the secret of our encounter, and they do not want to bother me. Kids, on the other hand, are great at doing this, and I always smile when they run up to me yelling “Dr. Janssen” or “Dr. David!”
In St. Matthew’s Gospel, Jesus summarizes God’s Law in two parts, the second of which being “Love your neighbor as yourself.” Rural medicine gives me the opportunity to practice this quite literally on a daily basis. Sometimes this can result in awkward encounters and push my level of comfort, but I would never trade the close bonds I have with community members for a little more anonymity. As I relearn all the rules to Dutch bingo, I am enjoying forming new connections and remembering old ones.