Perils and the pitfalls of rural medicine

Background

Rural communities are experiencing difficulties recruiting and retaining general practitioners. Often one of the reasons given for GP's not staying in their role in the rural community is that they are pushed by their partners/spouses to move back to metropolitan areas.

Rural GP work has particular challenges that are not only faced by the GP themselves but by their spouses which can include the crossing of personal boundaries and inability to maintain their own privacy. It is sometimes like being married to a 'Z' list celebrity.

As a wife of a rural GP for 10 years and also as a case loading NZ midwife in a rural community I have often faced these challenges which include:

• Coming across people in the street or social settings who like to tell you that he is a wonderful Dr, wonderful listener.

Now whilst I am immensely proud of my husband and I know he is a great Dr, he is also just a man. At home he does all the usual manly annoying things. Sometimes i have had to suppress the urge to shout, "but he is just a man! He is not some sort of Demi God!"

• Coming across strangers in the supermarket who like to say, "oh you're Dr Harnden's wife aren't you. I saw him yesterday about my haemorrhoids he sorted me out, wonderful man" 

Actually he doesn't and never has come home from work discussing the people and things he has seen at the surgery. That would breach confidentiality. I don't want to look at members of the community in the supermarket and be thinking of those haemorrhoids or sexual abuse or any other medical condition thanks.

• Another comment is also "I've tried to get to see that husband of yours but he is too busy do you think you could have a word with him?"

I am not his receptionist. The problem with my type of personality is that I tend to carry this with me and then I find I am asking hubby when he comes home from work to give them a ring which in turn then invades our family time together.

• Sitting in a local cafe enjoying a coffee with the kids and someone sits themselves down and begins what sounds like a medical consultation.

This raises huge issues of boundaries, confidentiality and invasion of privacy.

These are just a few examples I can think of many many more.

Personal Experience

Here in Australia I faced the challenge once again. My husband is currently away in Canberra presenting at a conference. At 9pm my mobile phone rang, a patients husband was on the end of the phone and preceded to tell me that his wife was in hospital, carrying on to explain her medical condition. She was going to be discharged the following day, "the hospital have done nothing for her" were his words and he wanted me to arrange for her to be seen by my husband the following day.

I had to politely explain that he is away in Canberra and that I have nothing to do with the medical clinic, I have no access to his appointment book and although I sympathised with his frustration he really needed to phone the clinic on the landline the following morning.

I am more than equipped to deal with these issues because of my professional background but it still left me unsettled for the rest of the evening on a number of levels. I felt anxious about her predicament and her suffering. I also felt a little resentful that the call had invaded my home life and worried about how I had represented myself and my husband on the telephone. Where do I stand when I'm asked for advice on the telephone? Especially in this climate of mandatory reporting here in Australia? Shit, actually the more I think about it the more I know I could have even been compromised severely in a professional capacity yet it was them that have invaded my privacy. I am a midwife anything that I said to her partner on the telephone could be misrepresented to the Nursing and Midwifery board and in this current climate I could face being struck off as having given advice that was out of my scope of practice. Yet I have never, ever invited such calls.

I am more than a little nervous because they also know where we live. What do I do if they turn up on the doorstep?

Much needed research

I would like to conduct some research into the thoughts and feelings of partners and spouses of rural GP's who have moved back to metropolitain areas. Maybe if we can provide more supportive measures to them it may improve GP retention in these vulnerable communities.