Intro

You may be a rural provider if...

You go downtown and half the people who say "Hi" are patients.
You can't find a mechanic who is not your patient.
Most of the people on your road know which church you go to, or when you don't.
You know who is in the car approaching you, by color and model.
Mail comes to your home with no more information than your name and town.
You know about half of the people mentioned in the newspaper, including the police blotter.
Folks don't really need to campaign for local elections, since everyone knows their story and character already. Folks just put signs up and pick sides.
People ask how your spouse is doing after a motor vehicle accident that you have not spoken about.
The clerk at the pizza place writes your name on the pick up coupon without their asking you to tell them who you are.
When you lock your keys in your car, you ask yourself whether you want to be on the police scanner or will just walk 2 miles to go home and get a spare.
You go to an Alanon meeting, and the next week at work, your patients ask you who your alcoholic is.
You can't find an alternative provider within 25 miles who does not have a conflict of interest for a particular patient.
In group supervision, after hearing three sentences about a patient, you know the family and the exact patient being spoken of, and can even add to the discussion.

Why live in a small town?

Fresh air, country pace, simple living, safe family atmosphere, knowing most folks, comfort and feeling you can really do something on a small scale in schools and community.

They say, 'You can't get rich in a small town... Everyone is watching." If you like the honesty of this sort of living, and the intimacy of knowing everyone in town, small town living is for you.

And, if a professional moves in, it will take just 6 months for all of the above events to happen to you. You got to love it, because the sweet quality of life is worth all of that.

Yet, how do we translate the complicated and seemingly distant Ethics Codes to the rural practice? It may seem impossible, but don't rural people deserve good care and qualified local practitioners to provide services for them?

Who are our Role Models?

The Country Doctor? Working long hours, a solid community servant, accepting chickens for payment?

The Family Practitioner? Seeing passels of kids and family members rotating through the office?

Deanna Troy? Psychologist on the Starship Enterprise? An embedded colleague and a confidant?

Freud? Blank slate - Tabula Rasa? No personal information available?

Clark Kent? Mild mannered and unnoticed by day, but in that little phone booth, transforms to Super-therapist?

The Hippie? Take me as I am - rebel and provider known to all?

The Urban Doc? An anonymous life - eating out and buying Lattes?

The Volunteer Fireman? Jumping out of community activities to put out emotional fires?

The Juggler? Never let them see you sweat, as you juggle all aspects of your life in the public's eye?

Our Topic - Professional Ethics applied to Rural practice settings

A way of thinking

Ethics - a tension of directives, with operator variables included.

Play the 'Match Game' ~
Folks, on the show, Gene Rayburn asks the question of his panel and studio audience -
So, let's see what our own audience says... First, the mood music ~

Click on the little play triangle for music

Ethical ________

And - Next question - What are your operator variables?
...More in this later.

Caution lights

The Ethics Code largely provides guidance and a framework for professional conduct and decision making. Expectations are defined.

Red lights

Very few specific outright prohibitions are referenced in the Code. Yet these are absolute when mentioned. Examples are sexual boundary violations and the exploitation of patients.

Rural Issues and relevant APA Codes:

The Codes previously seemed to expect that psychologists would have no other knowledge or interactions with their patients. The current Code places fence posts to assist the provider to define their field of practice. Some particular code items specifically come into play in the rural setting:

A structure to think through these decisions

Your flow chart

Dr Deborah Warner PLLC assumes responsibility for the content of this training.
CEUs: 3 hours in Ethics credits are sponsored by NBCC, the National Board of Certified Counselors. These credits are acceptable to the NH Mental Health Licensing Board.

Dr Deborah Warner may be reached at 603-444-1512 in Littleton, NH
DrWarner @ DrDebiWarner.com (please remove spaces before & after the @ sign)