Going remote - The highs and lows of a country practice

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Australian healthcare practitioners in rural and remote areas confront diverse challenges in their daily practice. Healthcare delivery in rural settings, as opposed to metropolitan health services, requires a greater diversity of abilities and knowledge due to the scarcity of resources and limited availability of support structures.

Rural health professionals, require a broader range of clinical and non-clinical skills to deliver care effectively. Often, doctors are called on to act as generalists instead of specialists placing a demand on rural practitioners to develop an increased scope of practice because, at times, they may be the only health professional available in each rural or regional setting1,2 

Specific challenges may include:

  • Minimal access to professional development
  • Lack of exposure to specialist practice
  • Lack of supervision and peer support
  • Absence of opportunities for inter-professional teamwork 
  • Large travelling distances within a widely dispersed and often isolated population
  • Lack of anonymity
  • The blurring of professional boundaries
  • Difficulty in maintaining private lives
  • Inability to find locum coverage when wanting to take a vacation or undertake activities for continuing medical education
  • Poor on-call arrangements with other general practitioners in the area

There are additional nuances to the Australian context that add extra challenges to rural clinicians:

  • Australia is a multicultural society with varying beliefs and religious practices.
    • It is not one culture, one religion and one language 
  • The class structure is built on equality and there may be no distinctions in hierarchy between patient and doctor.
  • Patients expect clarification and explanation, information and sensitivity and privacy, and confidentiality

Working within a close-knit community can bring with it many positive aspects such as familiarity with a healthcare provider that over time fosters comfort and relief for the rural patients they care for. There is a sense of connectedness with the community and the ability to provide ‘whole and multigenerational care’. Healthcare professionals in these settings are afforded a greater autonomy and the opportunity to utilise a wider range of clinical skills and also allows them to work in a cohesive and more supportive team environment within the rural practice.

MIPS' medico-legal advice

  • High quality contemporaneous documentation is critical for even low acuity presentations.
  • Matters other than the presenting complaint often form a key medico-legal risk for doctors as they may be highly important to the long-term care of a patient, but not be a high priority for the patient. Thus, documenting discussions around these risk factors is pivotal.
  • Clinical follow up and continuity of care is often a key point for medico-legal risk and is complicated in a small community by patient expectations, perceptions of ‘holistic care based on geography’ and lack of high-quality systems.
  • Documentation, discussion, and care delivery in emergency situations must be of high quality to both document interventions given and to protect the healthcare provider.
  • Health practitioners have an obligation to participate in, reflect on and learn from incident reviews
  • All MIPS members should notify and involve MIPS early, following a critical or unexpected incident to allow for their effective representation.

1Paliadelis, P. S., Parmenter, G., Parker, V., Giles, M., & Higgins, I. (2012). The challenges confronting clinicians in rural acute care settings: a participatory research project. Rural and Remote Health, 12(2), 194-205.

2Warburton, J., Moore, M. L., Clune, S. J., & Hodgkin, S. P. (2014). Extrinsic and intrinsic factors impacting on the retention of older rural healthcare workers in the north Victorian public sector: a qualitative study. Rural and Remote Health, 14(3), 131-146.

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This information is not intended to be legal advice and as such should not be relied on as a substitute. You may need to consider seeking legal or other professional advice about your individual circumstances as appropriate. Should you wish to obtain further information you can review our Member Handbook Combined PDS and FSG or contact MIPS on 1800 061 113. You may need to consider seeking legal or other professional advice about your individual circumstances as appropriate. Information is current as at the date published.

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