Caring for friends and family in rural practice

Can J Rural Med 1996; 1 (2): 94-95

In April of this year, RuralMed stumbled almost by accident onto an instantly recognizable feature of rural medicine that had not, it appears, been previously highlighted as a particular characteristic of rural practice.

It all started with a posting in which a physician described his experiences as a physician/husband/son during a series of serious illnesses in his family. From medical colleagues, house staff and nurses, he experienced both suspicion and hostility about his involvement, as well as (although less frequently) understanding and support. In dramatic fashion he raised the issue of what may happen when physicians are involved in the care of members of their own family and he confronted the taboos that surround this subject. Although not a rural physician himself, he suggested that variants of his experience might be common in rural practice.

Numerous rural physicians responded with anecdotes of their own, the most telling related by a rural surgeon who, being the only one trained in laparoscopic surgery in his rural community, chose, with his colleagues' support, to operate on his wife's ruptured ectopic pregnancy rather than subject her to a hazardous 4-hour transfer or accept a less than "gold standard" form of treatment. He found widespread support and understanding among his rural colleagues for his decision but reported being the subject of his College's censure for his actions.

Many participants in the discussion felt that there exists in urban circles a lack of understanding of the reality of this aspect of rural practice. It was also pointed out by one research-minded contributor that although the subject provoked many opinions, little research has been done in the rural setting. Lynn Dunikowski, the librarian for the College of Family Physicians of Canada, contributed the following references:

Reagan B, Reagan P, Sinclair A. 'Common sense and a thick hide'. Physicians providing care to their own family members. Arch Fam Med 1994;3(7):599-604.
La Puma J, Priest ER. Is there a doctor in the house? An analysis of the practice of physicians' treating their own families [review]. JAMA 1992;267(13):1810-2.

Rural doctors caring for family and friends seems to be a topic worth further study in the rural setting. Specifically, the following research topics were suggested:

What is the frequency and variety of "involved care" in rural and urban practice?
If it is frequent enough to provide meaningful data, what are the outcomes of "involved care" compared with "non-involved care"?
What is the impact of the doctor-friend of the patient on outcome when the main care source is "non-involved care"?
How does the care a physician receives differ from the "usual" care?

Several respondents felt that the experience of dealing with the medical problems of friends and family, although stressful, was not entirely negative. One commented, "It took me a while to finally feel comfortable in these situations and to realize that I could still be reasonably objective in my medical care. In fact I think these situations have helped me to see my patients in the context of their real life and provide better care than otherwise."

Whether rural physicians like it or not, they will find themselves confronted by this experience more frequently, and for more serious conditions, than their urban counterparts. Whether this is good or bad is perhaps not the issue for now. We need to explore the terrain. We may find out something new. If RuralMed has sown the seeds of some good ideas, it is doing its job.

Editor's note: Sometime in May, RuralMed passed the 200-subscriber mark. Although this is not yet in the same league as snow geese at Cap Tourment in the spring, it represents a significant new resource at the disposal of rural physicians worldwide.

To participate in RuralMed you must be able to send and recieve email. Subscription is by request to the listowner. Simply send a message to Dr. John Wootton at the following address:
jwootton@fox.nstn.ca
Please provide your email address and your full name. If you include a short paragraph about your interest in rural medicine, this will be posted to the list as your introduction. You can also access a subsription form on the World Wide Web via University of Calgary Department of Family Medicine home page at:
http://hippocrates.family.med.ualberta.ca/medical/rmform.html
RuralMed is archived by WebDoctor^TM, a Canadian Internet Web site run by Gretmar Communications. Old messages can be retrieved at:

http://www.gretmar.com/srp/home.html

Table of contents: Can J Rural Med vol 1 (2)