Letters / Correspondance
Can J Rural Med vol 2 (2):118
© 1997 Society of Rural Physicians of Canada
Victoria -- policy statement on rural obstetrics
Rural physicians, nurses, midwives and administrators met in Victoria from May 7 to 10 at a conference dedicated to rural obstetrics and hosted by the BC Reproductive Care Program. Three hundred delegates from across Canada were joined by representatives of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the Canadian Medical Protective Association (CMPA).
There was widespread recognition that without resources, special skills programs and guidelines appropriate for rural maternity care, many communities have lost, or are about to lose, services in rural obstetrics.
Speaker after speaker presented the case that:
- although hospitals may withdraw maternity services, they cannot withdraw maternity care, as women will always present to these hospitals with emergent maternity problems;
- there is a reduction in good perinatal outcomes in "high-outflow" communities;
- all of the available evidence, although descriptive and without great numeric power, supports the case that rural maternity care is associated with good outcomes;
- although full anesthetic and surgical services are desirable, good outcomes associated with rural maternity care can be sustained without local access to cesarean sections.
The delegates agreed to pursue, urgently and jointly with the Society of Rural Physicians of Canada (SRPC), the College of Family Physicians of Canada and the SOGC, the creation of a policy statement, supported by the CMPA, which would confirm that maternity care in rural communities, with and without local cesarean section capability, is appropriate and associated with good outcomes. The same process will then be used to revisit SOGC guidelines to adopt or adapt them for rural Canada. It was heartwarming to see the enthusiastic support and commitment from both the SOGC and the CMPA.
Stuart Iglesias, MD
Chair, SRPC Obstetrics Committee
Rural organizations: exploring the new media
I have become involved in the Society of Rural Physicians of Canada (SRPC) "experiment" in formulating rural maternity guidelines on the Internet. Why the Internet? Because the physicians involved live, by definition, some distance from urban centres, the business of gathering centrally to do committee work drains a lot of the energy from the work itself. Given that many in the group had met already through RuralMed or another email discussion group, the transition to doing serious work on the Net seemed natural.
Our experience was that the flow of information was rapid and almost overpowering. Within 1 month we had organized our thoughts into no fewer than 5 formal drafts, with input from dozens of people from 3 countries and 2 continents. Each draft became a tangle of many discussion threads from numerous authors, a process that I felt actually helped in forming consensus, since everyone had some ownership of the final product. The contributors included 2 authors of original research papers that we were quoting in our policy. Such rapid advancement would have been impossible for a group of people that large in a conventional boardroom committee structure.
However, in your own virtual conversations, be aware that remarks are often made "off the cuff." You have no hint of your correspondent's state of mind as you fire off your comment, unless and until s/he responds, and there is no body language or short verbal cues to help define a participant's mood. Contributions that are viewed as inappropriate by other participants may be met by strongly expressed reproof, which is called "flaming" on the Net, and it has happened within this group at least once. The telephone quickly solved any temporary impasses that were caused.
Overall, the experiment has been a terrific success to date. We have yet to work out the formal wrinkles of voting and decision-making, but this will probably be done by a motivated subset of the contributors using a virtual set of "Robert's rules" or a more traditional conference call.
Peter Hutten-Czapski, BSc, MD, CCFP
Haileybury, Ont.
Community relationships
The Society of Rural Physicians of Canada and your Journal have done an excellent job of highlighting some of the special problems faced by rural physicians. There is one issue that does not seem to have received much attention. It relates to the fact that rural doctors and patients live in the same community and are likely to come across each other outside the office. Rural physicians are quite likely to meet their patients, for example, in a queue at the grocery check-out -- patients who may have been refused a sick note or told they are alcoholics or prescription drug addicts. That can be bad enough, but it is worse to meet patients who think you have not treated them correctly, and worse still when they may be right.
David Howe, MD
Parrsboro, NS
Are you a rural doc?
Part 1: Score 10 points for every "yes" answer.
Are you recruiting?
Are you sleep deprived?
Do you forget the names of your spouse and children?
Part 2: Score 0 points for every (a) answer, 1 point for every (b) answer and 2 points for every (c) answer.
1. What percentage of emergency patients do you have no idea how to handle?
(a) <10%
(b) 10% to 20%
(c) >20%
2. Do you recognize your child in the school play?
(a) yes
(b) no
(c) have never seen the school play
3. You moved to your present practice location because:
(a) you like back-up and immediate access to specialists
(b) you like the lifestyle offered
(c) you would like the lifestyle, if only you had the time to do so
Scoring (for rural doc status)
04: not a rural doc
57: semi-rural or possibly a rural doc
810: rural physician
Carl Wisemer, MD (RD)
Cathy Scrimshaw, MD (RD)
Please send us your comments and opinions. Letters to the editor should be addressed to:
Canadian Journal of Rural Medicine
Box 1086
Shawville QC
J0X 2Y0
email cjrm@fox.nstn.ca
fax 819 647-2845
