The peculiar social, economic, and geographical characteristics of the rural setting contribute to the challenge of offering ethical health care to nearly 62 million residing in remote areas. For example, a third of Virginia’s population that is mainly rural frequently experiences the challenge of accessing medical care. Some of the features of the rural areas that hamper the process of furnishing ethical health care include the inadequate economic resources and healthcare services, traditions and individual values as well as the lengthy distance from urban areas. Other characteristics that act as an impediment towards the delivery of high-quality, affordable and accessible health care is the low density population in rural settings and most importantly, the nonexistence of single player system. In their article ‘Ethics of rural health care’, Lyckholm, Hackney, and Smith argue that the health care services offered in rural areas are poorer when compared to urban or suburban patient health services. The purpose of this paper is to identify and discuss the ethical issues affecting the standards of practice related to the competency of medical care. More specifically, the discussion shall confine itself towards discussing the ethical issues identified by the authors including issues concerning justice, medical competency, as well as confidentiality and privacy. This paper also seeks to shall explain the relevance that standards of practice have to me as a practitioner.

Issues Affecting Standards of Practice Related To Competency

The term justice, when used in the medical context refers to the equal distribution of health care resources. Therefore, the every person should be accorded medical care because of their specific health care needs regardless of whether they can afford it or not. Upholding this ethical practice is difficult due to the economic challenges and geographical barriers experienced in rural settings. Some health care practitioners might make decisions on the basis of the patient’s clinical impression instead of basing their choices on the current knowledge and technology. A research conducted by Cook, Hoas and Guttmanova in 2002 further affirmed that certain medical care providers agreed that they compromise quality due to the desire to work outside the rural areas where they trained. Patients who live in rural areas also experience financial challenges that are similar to those faced by the poor population of persons living in urban areas. However, this barrier is sometimes easily overcome in rural areas due to the fact that they live as a community. According to Purtilo and Sorrell’s evaluation of this issue, members belonging to a particular community in remote areas tend to help their members who experience financial constraints. Nevertheless, for a medical practitioner it is very difficult to make a decision on whether to provide the necessary care for a patient knowing that they may get a very little reward or none at all. Depending on the decision made, the health care provider might end up compromising the patient’s health as well as jeopardizing the practitioner’s overall. The situation even becomes more challenging for the provider when the person in need of care is a relative.

The competency issues affecting standards of practice in rural areas included the lack of competency to provide specialty care, direct supervision and continuity care and problems associated with handling and communicating medical information. The absence of specialty care in numerous rural area hospitals is attributed to the fact that there are only a few primary care providers in such areas and not specialized personnel. Research findings have shown that high-volume produces high quality and numerous rural hospitals regularly have low volume. Consequently, various medical practitioners might be forced to offer health care services that are beyond their level of proficiency. Lack of supervision is specifically detrimental to the health of patients suffering from problems that need to be brought to the attention of a specialist. The absence of continuity and care may affect the standard of practice because of the establishment of a poor patient-clinician relationship. The issue of dealing with and communicating information is closely related to confidentiality disputes. The rationale behind this difficulty is that maintaining respect for a patient’s privacy is almost impossible given that patients and healthcare practitioners live nearby. An investigation conducted in 1993 revealed that 46% of the interviewees working in small community were likely to have greater than 5% of patients who were family members or friends of the physician or staff.

Confidentiality and privacy are the other significant issues raised by the article. Confidentiality is one of the most important factors that underlie the relationship between a practitioner and their patient. They must, therefore, ensure that it is maintained at all times. However, the proximity in which the healthcare workers and patients interact in their daily lives in the rural areas increases the likelihood of knowing the patient personally as well as their behavior. This knowledge makes it difficult for the practitioner to maintain respect and for the confidentiality and patient privacy. A situation might also arise whereby the practitioner is placed in a dilemma to choose between whether to fulfill their obligations or protect the interest of their family members. Cook, Hoas & Guttmanova provide a good example of such a scenario where a practitioner might be forced to avoid recording information regarding a stigmatizing diagnosis of their relatives to protect their identity.

Relevance of Standards of Practice for a Practitioner

Professional standards are relevant to a practitioner in a couple of ways. First they serve as a guide to the minimum standards of practice expected of a professional. Professional standards should assist in shaping the behavior of a professional when in a particular situation. For instance, the standards help a person to maintain professionalism when faced with some of the ethical dilemmas discussed above. They, therefore, assist to demarcate the boundaries of professionalism where clear guidelines do not exist. The other effect of professional standards is the provision of sanctions where the professional falls short of the required standard. A healthcare expert is for instance expected to provide the highest quality of care because any negligence may result in the death of a patient. If a professional acts negligently, he is sure that punishment will follow due to the existence of professional standards.

Conclusion

The paper discusses the major issues affecting standards of practice related to the competency of medical care raised by Lyckholm, Hackney, and Smith. The issues discussed include justice, medical competency, as well as confidentiality and privacy. Access to justice is a challenging issue especially when practitioners are forced to choose whether to offer their services to financially constrained patients. Competency issues affecting standards of practice in rural areas included the lack of competency to provide specialty care, direct supervision and continuity care and problems associated with handling and conveying medical information. A provider may also be unable to maintain confidentiality and privacy as dictated by the standards of practice in rural areas. The impact of professional standards on a professional has been discussed and includes the promotion of professionalism as well as the provision of sanctions when in case the professional falls short.

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