In years three and four of their training, doctors who want to be general practitioners (GPs) spend time in both rural and urban practices. Often, if they are not from a farming background, they feel out of their depth dealing with farming patients as they are not familiar enough with the illnesses, stresses and dynamics of rural life.

To solve this problem a new training module is about to be introduced in the HSE northeast region with a view to supporting GPs more in their work.

If it is successful, it will be replicated in other HSE regions giving GPs more of a head start related to rural healthcare.

The topics will include farm accidents, lower-back pain and musculo-skeletal issues as well as illnesses that can be spread from animals to humans (zoonoses) like brucellosis, toxoplasmosis, ringworm and orf.

Irish Farmers’ Association (IFA) safety representatives will give a talk to the GPs and a visit to a farm will also be organised.

A rural-based physiotherapist will also provide information and there will be a presentation and workshop from the Ambulance service too.

They will also be made aware of farm financial and succession planning stresses by a rural solicitor and an IFA financial expert.

There will also be a focus on mental health, with training modules dealing with farm family issues and work patterns

Lifestyle issues will also be discussed during the lectures including the prevalence of obesity, type 2 diabetes, cardiovascular disease, skin cancer and reduced exercise due to mechanisation among the farming community.

There will also be a focus on mental health, with training modules dealing with farm family issues and work patterns, stress prevention and improving resilience.

The nuts and bolts of running a GP rural practice will be explained also along with pointers for combatting isolation as a GP.

Dr Joe Clarke is a GP in Summerhill, Co Meath and is the director of the HSE northeast GP training scheme.

Research shows that nearly half of them suffer from high blood pressure and cholesterol

“We saw a need because of what GP trainees were telling us. They wanted more specific training to work in rural communities.

"Farmers have particular health needs different from inner city and large urban areas and there is also a high degree of illness among farmers.

“Research shows that nearly half of them suffer from high blood pressure and cholesterol. Back pain is also an issue as well as a lot specific diseases that relate to farmers and rural communities including Farmer’s Lung disease, Weil’s and Lyme.”

Make rural practice more appealing

The extra training is also important in order to attract more GPs to isolated rural communities.

“In the last 10 years there’s been a migration toward the cities away from rural GP practice,” he says. “If there are more rural GPs, patients won’t have to travel as far. GPs can feel quite isolated in rural settings so it is more difficult to attract GPs to those areas so we thought that if you could establish a network of GPs with rural expertise and a real interest in being rural GPs that it would encourage more of the younger GP trainees to look with interest at practising within rural communities because they’d know they’d have support there. Rural healthcare could become a real area of interest.”

Zero applicants for rural practices

Finding GPs for rural areas is a major problem at present, he says.

“A few years ago you’d have 10 applicants for any one job. Now some lists advertise and they get zero applicants. Getting locums is difficult for rural GPs, too, so they find it hard to get holidays or attend meetings or training days.”

This new module will be a European first, he points out.

“Internationally, there is very little training like this apart from in Australia so we’re excited about this initiative and seeing it rolled out across the country. It’s quite an exciting, innovative project which we hope to build on.”

The on-site farm visits will be very useful, he says. “Health and safety on the farm is something that GP trainees wouldn’t be familiar with unless they are from a farming background so it’s very important that they should familiarise themselves with what can happen.

“The discussions with farmers will also bring up what the needs of the farming community are in terms of GP service and how we can tailor the service to those needs so there will be a research component to this module also.”

Psychotherapist Enda Murphy may be familiar to readers from his radio spot with Dr Harry Barry on RTE Radio One’s Today With Sean O’Rourke programme. He also happens to be the assistant director of the northeast vocational GP training programme with the HSE so he has also been involved in developing the prospectus.

“Only a percentage of the current GP trainees are from a rural background,” he says. “So it was therefore decided that there was a need for a programme to help doctors understand and effectively respond to rural issues.”

Input from the rural community was necessary in designing the training module so the planners have been working closely on this with the Irish Farmers Journal and the IFA farm family committee.

“Having the IFA and the Irish Farmers Journal on board was a Godsend,” Enda says, “as they had conducted research that was invaluable in ensuring that the completed module was representative of health problems facing rural Ireland today.”

A rural doctor

Dr John MacMahon is a GP in Kingscourt, Co Cavan, as well as training GPs in rural medicine. Described by his colleagues as a “dyed in the wool rural GP” his daily schedule involves surgery, after hours rosters and also being team doctor for Kingscourt GAA.

His emphasis is on how a rural GP has to be able to stitch wounds.“The big difference between urban and rural practices is that in rural practice you are the casualty department as well as everything else,” he says. “In bigger towns, if someone gets a cut or twists their ankle they go into the emergency department of the hospital. Whereas in a rural practice they come to us or call us. We stitch people, we take bits of steel out of people’s eyes, we do all the kinds of things that a casualty department does and we’re often not acknowledged for that.”

When GPs come to do their year in a rural GP practice they find a huge difference from urban practices, he says.

“They’d have a guy coming in who needs six stitches and of course in a rural practice if you couldn’t put in the six stitches people wouldn’t believe you were a doctor, would they? So we’ve always done that and it’s quite an enjoyable thing to do and patients are delighted that we do that for them because if you go to casualty today at 12pm you’d be lucky enough to get out by 8pm or 9pm.”

Most are uneventful but you have to be ready for whatever happens

Being present at sporting events means being prepared for anything, says the doctor who has been to a thousand games.

“Most are uneventful but you have to be ready for whatever happens. You could be dealing with anything from a head injury to a broken leg to a collapsed lung to a ruptured spleen. I’ve seen almost every injury in my time.”

A member of the GAA Team Doctors Association he has always carried a defibrillator with him.

“They are no good unless you have people who can do CPR though, so training people for that in the clubs is crucial.”

Dr MacMahon has been called out to many car crashes in his time, particularly in the 12 years he worked single-handedly in a practice.

“I’ve been at several road deaths in my time – too many – terrible accidents. You cope because you’re in the situation where you’ve got to do the best thing you can do.

“It can be very tricky. In a rural area it can be 40 minutes before the ambulance can get there. That’s a long time if you’re with someone who is critically injured. As rural doctors, years ago we would have equipped ourselves with all the basic medical equip needed for severe road accidents.

Rural GPs developed their own kind of network

"We had to do that more or less out of our own pockets. You had to carry the proper equipment, instruments for giving someone intravenous lines to keep them alive, splints, oxygen and so on.

“Rural GPs developed their own kind of network for providing that kind of service because there is nothing worse than being at the scene of an accident and feeling that you could do something but you haven’t got the equipment.”

In relation to farm accidents, GPs often see animal-related accidents.“You could see somebody who’s been caught in a crush with a wicked cow or a bullock. That can cause a lot of injuries. The most serious injuries are from the big machinery, of course.”

Obesity is a factor for farmers as well as everyone else, he says. “I wouldn’t notice in our practice that farmers would be any less healthy than any other sector, but I think they’ve improved in relation to looking after themselves. They’ve become aware that it’s not such a bad idea to have a check-up.”

You’d be very proud of the training and the quality of GPs coming in

This new training module is a good idea, he says. “There are plenty of doctors who never stood on a farm in their life and have no idea of the problems that can exist.”

He believes that GPs give a fantastic service. “You’d be very proud of the training and the quality of GPs coming in. You’re talking about hugely competent doctors, well qualified, which is great. Most of them remark that the farming community are kind, warm people to deal with as a rule,” he says.

Why we need rural GPs

A 2017 survey of GP trainees and graduates showed that:

  • One in five recently qualified GPs have already emigrated.
  • A further 30% of newly qualifies GPs were considering emigration.
  • Enda Murphy is author of Five Steps to Happiness: Learning to Explore and Understand Your Emotional Mind