RuralMed grab bag
Can J Rural Med vol 3 (1):44-45
© 1998 Society of Rural Physicians of Canada
A discussion of mammography and its availability to rural women was sparked by one Quebec based RuralMedder. He indicated that Quebec's new breast-screening program is applying the same quality criteria to all sites, both urban and rural. All technicians must do a minimum of 1000 per year, but his hospital's 2 technicians do only 700 between them. If the rule goes through women in the area will have to travel 140 km, round trip, to obtain mammography service.
The discussion centred on the transportation problem, and some RuralMedders said that their female patients get used to travelling for mammography, especially when they realize its importance. One added that lots of his patients do 190 km round trips just for groceries. . . . In Australia, which has a mobile unit that tours the country, women must still travel for diagnostic (versus screening) mammography.
The discussion continued with one RuralMedder asking what will happen to the local provider of specialty services if rural areas are increasingly restricted by urban based rules. "Is the surgeon going to be deprived of patients who perceive that they should go to the city to get 'better' care? What about the local GP and his or her skills? Whatever happened to comprehensive care? Isn't our insight, knowledge of the patient and community supposed to yield better outcomes?"
Another thread concerned the tendency of some problem patients to jump the office queue and go to the emergency department to see their doctor about a cold. However, one RuralMedder noted that, "A few patients with colds help pay off the pickup truck easier than a half dozen internal medicine referrals." Sick notes are another headache when either employers demand them or the foreman says s/he won't let a worker back without one. Advice from RuralMedders was that the companies involved be informed that if sick notes are demanded unreasonably, the company will be billed by the patient's doctor. Another solution is to hand the patient the Canadian Medical Association policy statement on the certificate of disability (www.cma.ca/inside/policybase/1997/5-0b.htm) and explain that doctors cannot act as policemen for the employer.
One RuralMedder suggested that health promotion in rural areas could be far better than it is. Others then recounted failed efforts at creating smoke-free zones in towns where the majority of the councillors smoke. One RuralMedder suggested that to get smokers to quit you need special services, and many rural areas don't have services for such things as smoking cessation, bereavement, cancer and victims of sex abuse. "Sometimes the only support is tobacco," he writes.
Concern was expressed over the closure of the 1-year anesthesia training program at the Toronto East General Hospital and the threatened closure of a similar one in Calgary. RuralMed was told that the SRPC has an anesthesia committee and will need to address questions as to who should teach a GP anesthesia course, how long, where, what and how. The course seems to be a grab bag at the moment, with no specific program, no consistency across the country and no diploma. Rural doctors need to develop their own program since anesthetists don't stay in rural communities because the work is not varied enough for them. "Someone has to work the general surgery cases that are the meat and potatoes of the rural [surgeon]," noted one RuralMedder. Some RuralMedders suggested that the SRPC committee can preserve, support, validate and expand the role of GP anesthetists in Canada.
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