Original Research

The impact of interpersonal relationships on rural doctors’ clinical courage

AUTHORS

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Lucie Walters1
FACRRM, Director *

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Ian Couper2
MFamMed, FCFP(SA), Professor and Director

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Ruth Stewart3
FACRRM, DRANZCOG adv, National Rural Health Commissioner for Australia

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David G Campbell4
MBBS, FACRRM, Censor in Chief

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Jill Konkin5
CCFP, FCFP, FRRMS, Interim Coordinator Rural Integrated Community Clerkship

AFFILIATIONS

1 Adelaide Rural Clinical School, Faculty of Health and Medical Sciences, University of Adelaide, Mount Gambier, SA 5290, Australia

2 Ukwanda Centre for Rural Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa

3 College of Medicine and Dentistry, James Cook University, Thursday Island, Qld 4875, Australia

4 Australian College of Rural and Remote Medicine, Cunninghame Arm Medical Centre, Lakes Entrance, Vic. 3909, Australia

5 Office of Rural & Regional Health, Division of Community Engagement, University of Alberta, Edmonton, AB T6G 2C8, Canada

ACCEPTED: 18 July 2021


early abstract:

Background: Clinical courage occurs when rural doctors push themselves to the limits of their scope of practice to provide the medical care needed by patients in their community. This mental strength to venture, persevere and act out of concern for one’s patient, despite lack of formally recognised expertise, becomes necessary for doctors who work in relative professional isolation. Our previous research suggested that the clinical courage of rural doctors relies on the relationships around them. In this paper we explore in more depth how relationships with others can impact on clinical courage.
Participants/Methods: At an international rural medicine conference in 2017, doctors who practised rural/remote medicine were invited to participate in the study. Twenty-seven semi-structured interviews were conducted exploring experiences of clinical courage. Initial analysis of the material, using a hermeneutic phenomenological frame, sought to understand the meaning of clinical courage. In the original analysis, an emic question arose: “How do interpersonal relationships impact on clinical courage”. The material was reanalysed to explore this question utilising Wenger’s community of practice as a theoretical framework.
Results: This study found that clinical courage was impacted upon by the relationships rural doctors had with their communities and patients, with each other, the local members of their health care team and with other colleagues and health leaders outside their immediate community of practice.
Conclusion: As a collective, rural doctors can learn, utilise and strengthen clinical courage and support its development in new members of the discipline. Relationships with rural communities, rural patients and urban colleagues can support the clinical courage of rural doctors. When detractors challenge the value of clinical courage, it requires individual rural doctors and their community of practice to champion our way of working as rural doctors.