David Gutman, MD, FACG, has been a gastroenterologist for more than 30 years. Most of that time he spent specializing in reflux at his practice in Mineola, N.Y. But in February, he moved five and a half hours north to the village of Carthage, N.Y. Known for its forest land, streets lined with Victorian homes and proximity to the military outpost of Fort Drum, Carthage and the military base are tended by a cast of primary care practitioners. However, Dr. Gutman is the only gastroenterologist in the area—with a surrounding population of roughly 20,000. He is, in fact, the first GI ever to practice at Carthage Area Hospital.

Dr. Gutman spoke to Gastroenterology & Endoscopy News about his experiences, including some surprises in patient profiles and workplace technology, for this new series exploring clinician life across the country.

Editor’s note: This conversation has been edited for clarity and brevity.

GEN: When you were looking at places to practice, were you aware that Carthage didn’t have any GI specialists?

Dr. Gutman: No, that was actually a scary part. That’s always a scary thing because then you have to create from nothing—although I’m pretty good at that in general—but that doesn’t mean it’s less scary.

For example, the surgeons had been using bowel preps that had been outdated for 10 years. We had to update standards here. It’s a little scary but that’s OK. There’s always something scary in growth, and you just handle it. It’s totally acceptable and leads to good outcomes.

GEN: Did the new hospital meet your expectations?

Dr. Gutman: Yes and no. Particularly from the friendliness and accessibility part, yes; what I didn’t expect was for my patients to be saying “yes, sir,” but that’s the way they’ve been encultured. And of course, there are aspects that need ongoing work and development to bring it up to full standards, but the administration has been receptive to that.

GEN: Have you experienced any difficulties specific to the region or specific to the military population?

Dr. Gutman: That’s a very interesting question. There are a great many people here who are under tremendous stress—PTSD [post-traumatic stress disorder], or basic training, or constantly having to move. You know, “I was at a fort in Louisiana and now I’m at a fort in New York,” and the discontinuity of care in between.

Of course, the gastrointestinal tract is filled with the physical manifestations of stress, whether it’s dyspepsia or irritable bowel syndrome or alterations of bowel habits. Soldiers have five-minute allotments to go to the bathroom and if they can’t do that, then they come back very constipated.

The manifestations of PTSD are very interesting because we see that not only in the active soldiers but the ones who have stayed in the community with their families. So there are significant issues related to military populations. They may also tell you, “I was in a military hospital in Korea, but I can’t tell you much about what happened there because I couldn’t communicate with my doctor. Just tell me what was wrong with me. I think they might have taken out my appendix.”

The two most common places for them to have been, other than Afghanistan and Iraq, are Germany and Korea—especially Korea. So there is some fragmentation in their care that you have to overcome to try to improve. I had a patient who described a 12-year history of IBS, but nobody followed through with the treatment. And I had a mother of a soldier; the mother is in Oklahoma and she’s very concerned about her son who has signs and symptoms of IBD, and she’s too far away to be there for her 19-year-old son. And he’s reserved.

You forget sometimes that these are kids in harm’s way. They’re big bruisers of kids, but they’re still kids. And when things are really not well controlled, with the resources of having the family around you, they’re missing out.