Balancing the personal and professional
New UNBC research on rural doctors and their overlapping relationships
By Abigail Popple, Local Journalism Initiative Reporter, RMG
Dr. Andrea Gingerich, an associate professor at UNBC, has documented experiences that health practitioners in the Robson Valley may be familiar with: awkward moments of treating your neighbors, accountant, or coworkers. Gingerich and her team recently published two studies examining how doctors and physiotherapists in rural B.C. navigate these overlapping relationships in the journals Medical Education and Advances in Health Science Education.
Despite the reality that practitioners in small, rural communities often know their patients on a personal or professional level, it’s not a topic that many discuss openly, according to Gingerich. The regulatory colleges that oversee healthcare providers encourage practitioners to maintain strict boundaries with their patients, to make sure their treatment of patients comes from an objective viewpoint.
“The regulations are more suitable for an urban context, where the assumption is that you can have patients who are strangers or refer the patients you do know to someone else,” Gingerich told The Goat. “That’s not the case in rural places.”
The problem gets more complicated for rural healthcare providers with a very specialized practice, Gingerich added. For example, physiotherapists who specialize in pelvic floor treatments might be the only available option for patients within an area spanning hundreds of kilometers.
“The right answer to adhere to the college’s regulations would be to say, ‘No, I won’t treat you,’” Gingerich said. “But if you say no to them, you could be preventing those patients from getting the best care.”
While knowing their patients puts rural healthcare workers in an awkward spot, they have developed strategies to navigate overlapping relationships, Gingerich’s team found in their interviews with practitioners. The studies document these strategies – such as suggesting patients only discuss their issues while in the clinic, rather than at social gatherings or other public settings – which Gingerich hopes will lay the foundations for further dialogue about overlapping relationships.
“It’s pretty early work – we’re just getting those descriptions (of overlapping relationships) and starting that conversation, reminding people of what the reality is of practicing in rural communities,” Gingerich said.
Gingerich is continuing this research by looking into how students and medical residents are impacted by overlapping relationships, and how school curriculums could better teach future practitioners how to navigate the relationships. She and her team also plan to look at patients’ complaints to regulatory colleges, to determine what makes an overlapping relationship problematic from the patient’s perspective and how that can be avoided.
“Explicitly making that connection between the practice standards on dual (overlapping) relationships and its impact on practitioners is what makes (the studies) unique,” Gingerich said. “At first blush, it seems prudent to avoid overlapping relationships wherever possible, but we’re looking at the consequences of doing that.”
One potential consequence that has yet to be examined fully is how overlapping relationships could contribute to burnout, and lead doctors to leave their rural communities. When doctors feel they can’t nurture personal relationships in case they end up treating their friends, it can prevent them from feeling like they have a place in their community, according to Gingerich.
“Practitioners who feel like they belong in a community tend to stay, and to be able to belong, you need to have friendships and participate fully in social activities,” said Gingerich.
