Dr. Blair Stanley vividly remembers the challenging incident that made him rethink the medical field’s culture of stoicism.
“I was working in a tiny emergency room,” says the veteran family doctor who has worked across British Columbia (BC), in the Arctic, and now in Vernon.
“The trauma bay was just chaos—there was stuff everywhere—IVs and equipment,” he explains. “I just remember looking at that poor person who was now dead…the staff and his family had left, and it was now just me and him.”
With the emergency room now backed up with about 20 patients, Dr. Stanley had to immediately brush aside the devastation of losing a patient and move on to the next—a person with a sore throat.
“At that moment, it was profound to me that the expectation was to go through this horrendous experience and then just shift gears and go on,” he says. “I felt resentful about it…and started wondering what effect this has on me, the staff around me, and those patients after I’ve gone through an experience like that.”
He wasn’t alone in those thoughts.
Stress and personal emotional trauma surrounding a challenging incident in rural medicine—including cases that involve a child, friend, family member, multiple casualties, or tough situations related to a poor patient outcome—lead many medical providers to rethink rural practice. Some avoid it. Others leave it.
Dr. Ed Marquis, another family doctor who has worked for decades in rural BC, now in Prince George, explains that working alone, or on extremely small teams, can result in a troubling lack of personal and professional support—especially when challenging incidents inevitably arise and accumulate over time.
“Most of us are good for a few of those challenging incidents and then they start to build up in us,” says Dr. Marquis. “And if we don’t have a way to talk about them and release them in a safe environment…it’s one of the reasons that folks sometimes step away from isolated rural practice.”
Most of us are good for a few of those challenging incidents and then they start to build up in us,” says Dr. Marquis. “And if we don’t have a way to talk about them and release them in a safe environment…it’s one of the reasons that folks sometimes step away from isolated rural practice.
Dr. Ed Marquis
With this in mind, Drs. Marquis and Stanley set out to change the culture of rural medicine by offering isolated rural doctors, nurse practitioners, and nurses a safe space to talk about the challenging incidents they experience in the course of their work.
In December, the doctor duo, together with Adrienne Peltonen and Kassia Skolski, launched the Isolated Medical Provider Aftercare Team at the Rural Coordination Centre of BC. IMPACT, as it’s known, offers peer-to-peer support to rural doctors and nursing station nurses who may have experienced a challenging incident. The program is currently being piloted in the Northern Health Region with the aim of rolling it out province-wide in the coming months.
Through the program, IMPACT Peer Supporters connect with isolated rural medical providers and listen, offer empathetic support, and link them to other resources in the community. The Peer Supporters do not provide clinical counselling or feedback on the care provided by the isolated medical provider.
“In that emergency room that day—and many other days—I didn’t really feel that there was a place that I could reach out,” says Dr. Stanley. “I felt very isolated because I didn’t think that many people would understand what I’d gone through. But I know that other rural physicians get it. I know that they understand. So that would have been nice…someone to reach out to…someone to call.”
In that emergency room that day—and many other days—I didn’t really feel that there was a place that I could reach out. I felt very isolated because I didn’t think that many people would understand what I’d gone through. But I know that other rural physicians get it. I know that they understand. So that would have been nice…someone to reach out to…someone to call.
Dr. Blair Stanley
As Dr. Stanley points out, rural medical providers are most comfortable speaking with other rural medical providers because they understand the challenges of delivering care in small, limited-resourced communities. As a result, IMPACT ensures that its Peer Supporters work, or have worked, in rural settings. To make the peer support space even safer for isolated rural medical providers, all peer support discussions are completely confidential, and IMPACT makes no documentation of the contents of the calls.
Dr. Marquis hopes that, over time, much-needed peer support programs, like IMPACT, will become more common for medical providers, particularly rural doctors, and normalize provider wellness as a part of difficult event follow-up:
“If you look across industry—military, police, firefighters, ambulance personnel—they all have programs in place to recognize when a traumatic event has occurred and proactively reach out in support,” says Dr. Marquis. “We don’t do that anywhere on the planet with our rural colleagues—we just assume that since we’re the team lead, we must be immune to that stuff. But we know that’s not true.”
To access IMPACT peer support, isolated rural medical providers who have experienced a challenging incident can call 1-236-361-9090. In addition, colleagues—such as patient transfer coordinators, chiefs of staff, medical directors, and Real-Time Virtual Support physicians—who are concerned about an isolated rural medical provider can call that number to request that an IMPACT Peer Supporter check in on an isolated rural medical provider. An IMPACT Peer Supporter will call the isolated rural medical provider within 72 hours.
As Dr. Stanley closes his memory vault to the numerous challenging incidents that both he and Dr. Marquis have experienced over the course of their careers, he offers some words of advice to isolated rural medical providers who might be going through a difficult time:
“Don’t be so hard on yourself—these are really difficult situations. If you’re able, reach out and connect with IMPACT because it really helps. We’re here for you. We have a team of rural medical providers who really care and understand and want you to grow through those experiences. And we’re grateful for the work that you do—that doesn’t get said enough.”
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For general questions about IMPACT, please email [email protected].