President's message: This is a hold-up
Keith MacLellan, MD
Shawville, Que.
President, Society of Rural Physicians of Canada
Can J Rural Med vol 2 (2):61
© 1997 Society of Rural Physicians of Canada
When asked by a "motivational speaker" to name the best thing about rural medicine, one of the members of the Society of Rural Physicians of Canada (SRPC) thought for a while, then broke up the meeting by saying, "Well, we get every third weekend off." But seriously, what is a decent on-call schedule? Has any research been done? The Canadian Association of General Surgeons states that no surgeon should work more often than a 1-in-5 call, which must generate real laughter among rural surgeons. Are such guidelines useful to rural physicians?
What are the minimum standards of proficiency for working in rural emergency departments, delivering babies, putting in pacemakers, anesthetizing patients and broaching the abdomen? Should the standards of care for common medical problems (such as myocardial infarction, stroke and croup) always be those of tertiary care centres? Who should be transported, and, given the impossibility of a fail-safe, 24-hour, all-weather transport system, how should the rural doc be trained?
These questions and many more have been plaguing rural doctors for decades. When we turn for guidance to our professional associations, universities and governments, we are often disappointed, because their structures have not been able to accommodate realistic rural concerns, but sometimes because of outright antipathy or perceived "turf" concerns. When we do get guidelines, they often make no sense when applied to conditions in the field, and they usually make life more difficult.
These are the reasons why the SRPC will make a major effort in the coming years to issue realistic, well-researched and specific guidelines and policies on a variety of rural practice topics. If these guidelines are based on the best available evidence, are sanctioned by a strict peer review process, are backed by expert consultation and conform to actual field conditions, then they will carry considerable weight with administrators, medicolegal authorities, training institutions and colleagues in other fields. Many of these guidelines will overlap with the concerns of other bodies and, wherever possible, joint statements with other medical associations will be sought. Most importantly, SRPC guidelines will not only improve health care delivery for rural communities, but will also give the individual rural doctor support when fighting for improved working conditions or equipment, facing legal difficulties or saving a hospital from closure.
Guidelines can be a double-edged sword and may restrict as much as they facilitate. That is why we need you, the doctor at the coalface, and not the urban-based administrator, to help us to formulate them. If rural physicians don't do it, either nobody will, or guidelines will be imposed, as has been done in the past. On the other hand, no system for issuing practical, facilitating guidelines will function for long unless those doing the work are compensated, at least to some extent. Money is essential.
So this is a hold-up: give us your money, by joining and getting others to join the Society of Rural Physicians of Canada, or your time, by participating in a committee -- preferably both. The pay-off for you, your colleagues and your patients should be enormous.
