When the ear exam is finished, I’m ready to inspect the throat. I stand in front of my patient, aim a flashlight at their mouth and ask them to open wide. Three-quarters of people open their eyes widely instead of their mouth. Research paper!

Occasionally a detailed eye exam is required. Some people are unbelievably calm when it comes to having their eyes checked – irritating drops and dazzling lights shone directly into their pupils don’t faze them in the slightest. Others are eye wimps – the instant the ophthalmology tray is brought out they reflexively scrunch their eyelids shut so tightly a crowbar couldn’t pry them open. It usually takes a fair bit of cajoling before these folks will allow me to proceed. Years of examining eyes have taught me that there are four cardinal directions: up, down, left and the other left. “Okay, Ms. Knowles, please look to your left. No, the other left.”

Next comes the throat. When I push down on someone’s tongue with ye olde glorified Popsicle stick and ask them to say “ah,” it’s not because that’s how I get my jollies. Saying “ah” makes the soft palate rise, which makes it easier for me to visualize the back of the throat. Half the time I ask patients to say “ah,” they either straight-up don’t do it or else they try to fake it. What? Do they think I won’t notice? Hel-lo, McFly, I’m right here! I notice! Say “ah!”

I just love it when someone a foot and a half away from me spontaneously ejects their dentures to show me a lesion in their mouth. Isn’t there some sort of unwritten rule of social conduct that stipulates prior to popping out one’s false teeth, a person is supposed to give innocent bystanders fair warning? I’m still waiting for the day somebody asks me to hold their drippy dentures for them.

Chest auscultation is always interesting. When asked to take deep breaths, many people take one deep breath and hold it. How is that supposed to help me? Sometimes I’m tempted to sit back and wait to see how long they’d last. And then there are the times when patients seem to forget how to breathe and I end up having to remind them to exhale after each inspiration. “Deep breath…exhale! Deep breath…exhale!” When I get tired of repeating myself I say, “That’s good! Just keep doing that, okay?” Seems to work.

While I’m on the topic, what mysterious force compels people to start talking to me while I’m auscultating to their chest with my stethoscope? At least once a day I’ll be straining to decipher a subtle heart sound when suddenly “My great-grandmother died of a heart attack when she was 98!” explodes into my eardrums. Now that’s annoying. Minus 10 points.

The umbilicus is the centre of the abdomen. Heck, it’s practically the centre of the entire body. You’d think people would make an attempt to keep it clean, right? Maybe even treat it to a little soap and water once in a while? Don’t count on it. I’m here to tell you that the hygienically-challenged walk among us. Some belly buttons are so full of dirt, you could plant an oak tree in them. Others contain enough lint to fill a Beanie Baby. Wash your belly buttons, people! This has been a public service announcement… .

Centuries ago, when I needed to evaluate male patients for groin hernias I would insert my gloved finger into their inguinal canal and ask them to cough. This inevitably resulted in them coughing all over me. Nowadays I say, “Please cover your mouth and cough.” My patients often look a little baffled when I make this request. Maybe they’re thinking, “You mean I don’t get to cough on you anymore? Bummer!”

Sooner or later all good things must come to an end. Once the examination is over we discuss my findings as well as any recommended investigations and treatments. When we’re finished most people say thanks, walk out and shut the door behind them. I’m never quite sure why they close the door. Perhaps they think I plan to teleport out of the room. Fortunately, I’m not claustrophobic. I finish my charting, reopen the door and mosey on down the hall to see what new challenges await me.

Survey Says…

My desk is littered with surveys. We rural physicians are a hot research topic these days – everyone wants to know what makes us tick. I imagine the brainiacs in their think tanks across the nation scratching their heads, vexed and perplexed.

“What makes them venture beyond city limits?” they ask one another. “And more importantly, what keeps them out there?” More fruitless head-scratching. Suddenly one of them leaps to his feet. He looks excited. Head Boffin arches a bushy eyebrow in the direction of his impulsive young colleague.

“Yes?”

“Sir, I’ve got it! Let’s send them all surveys!”

“Surveys?”

“Yes! We’ll ask them each a few hundred questions and then have our quantum computers analyze their responses!”

Head Boffin nods; slowly at first, then with increasing enthusiasm. Finally he breaks into a wide grin.

“Splendid idea, Dilton! First class! We’ll start immediately.”

And so it begins.

My receptionist unceremoniously dumps the morning mail onto my already overflowing desk. Junk, bills, test results, insurance forms, more bills… and two objects that look suspiciously like surveys. Shoulders sagging, I open the first one.

“Dear doctor, we truly appreciate you dedicating your life to rural medicine yada yada yada and we hope you won’t mind filling out the enclosed survey. Please review the following 200 items and rate their importance in terms of the impact they have on your desire to continue practicing rurally. We estimate this survey should take you no longer than 45 minutes to complete.” What?! 45 minutes? Are they nuts? I’ll be lucky if I get 10 minutes for lunch today! I wad the oversized monstrosity into a ball and three-point it into the recycling bin across the room. The crowd goes wild… .

Item two is a follow-up letter from a group whose survey I completed a few weeks ago. As I recall, this particular survey had asked more personal questions than most, but its authors had gone to great lengths to assure that all responses would be held in the strictest confidence. They also promised names would not be linked to the forms, so it would be impossible for them to trace answers back to the individual respondents.

“Dear Dr. 655, thank you very much for taking the time to fill out our survey. We notice, however, that you neglected to answer questions 19 and 99. Please complete them and return the form to us in the enclosed self-addressed envelope.”

Okay, this I can handle. I quickly finish off the questionnaire and drop it in the outgoing mail tray. Several hours later the penny drops – if they claim to be incapable of tracking the doctors filling out their surveys, how did they know the incomplete one was mine? Egads! I’ve been duped! With my luck the study will turn out to be the product of some nebulous federal intelligence-gathering agency. Good thing I didn’t mention my fluffy pink slipper fetish in the “deviant tendencies” section… or did I?

Although surveys can be a real nuisance, I’ll probably continue to fill out the shorter ones for years to come. Why? I figure those poor research eggheads need all the help they can get in their noble quest to decode the enigma of the rural physician. If they eventually succeed, perhaps one day we’ll be featured on a segment of Hinterland’s Who’s Who. First will come the familiar, haunting flute melody, followed by that unnaturally calm voiceover: “The Canadian rural physician is a peculiar beast that appears to thrive on challenge and adversity. Only recently have scientists come to understand why this curious creature voluntarily makes its home in the underpopulated nether regions of our great land… .”