Articles and Case Studies

The Essence of Family Medicine in Rural Practice

02 Nov 2016

by Dr Alexandra Smith

I was stuck behind a tractor on my way home today, in one of those quintessentially “country” moments, driving along at 30km per hour past paddocks of sheep and cows. I didn’t mind as I wasn’t in a rush, and I found myself thinking that I actually know a lot more about the fellow driving the tractor than he realises.

It’s one of the pleasures of general practice, and rural practice in particular, that we are allowed to get to know whole families and their stories. I knew this particular young man had bought the tractor with his own hard-earned cash as it had an air-conditioned cabin for comfort in summer – good for sun protection (he has a strong family history of skin cancer). But he is teased mercilessly about this by his grandfather who is also my patient and the source of this country gossip.

Rural general practice in particular allows us to form relationships with our patients that I feel our urban colleagues at times miss out on, particularly in tomato season when our staff room starts to smell like a passata-making party!

Providing a “medical home”

I practice in the Huon Valley, Tasmania, a picturesque region 40 minutes south of Hobart, quickly becoming renowned for cider and as a foodie destination. Like much of Tasmania, the demographic is varied but does include an ageing population as well as a cohort of people at the lower end of the socio-economic spectrum. This means a lot of our patients have a chronic disease burden contributed to by their poor social determinants of health. Despite the “foodie” reputation of our area, fruit and vegetables are relatively expensive, and there is a constant flow of people in and out of the local fried food shop.

I believe that our role in general practice, by establishing and nurturing the therapeutic relationships we have with our patients, allows us to effect change in the community at a grassroots and individual level, or even at a family level. This may be part of what is often referred to as the “medical home”, the concept of having a person or place to continually come to – who knows you and your medical history, and is able to coordinate your care and put this into the context of your social situation as well as your frame of mind.

There is a limit, of course, to how much of an effect we can have at a grassroots level – and the gap is filled by public health and workforce measures, which are important to reduce the discrepancy between health outcomes in the city and the country. I am involved in advocacy not only for my colleagues, but also for my patients. I can’t force shops to sell fruit and vegetables more cheaply, but if people who can’t afford it have to pay more to see the doctor, it’s less money they have for fresh and healthy food, a gym membership, or access to the local pool.

Maintaining the essence of family medicine

At our practice, despite the rural location, we are always looking for new and innovative ways of treating our patients, increasing engagement with them, and offering services to benefit the community. We have a dietician, exercise physiologist and psychologist on site, and recently employed a full-time clinical pharmacist, the first in Tasmania to work in general practice. We are very proud of the quality of care this enables us to offer.

It was never our intention to become a “superclinic”, but to increase access to services for our patients who would otherwise have to travel. It is a fine line, and we try very hard to make sure that we continue to maintain the family practice feel. If we lose that, we lose the essence of family medicine – the cradle to grave therapeutic relationship.

Dr Alexandra Smith (MDA National Member)
President, Rural Doctors Association of Tasmania
Managing Director, Huon Valley Health Centre

Dr Alexandra Smith's photo featured above, courtesy of The Royal Australian College of General Practitioners.
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